CLINICAL PROGRESS IN THE TREATMENT OF EXOPHTHALMOS OF GRAVES' DISEASE, WITH PARTICULAR REFERENCE TO THE EFFECT OF PITUITARY SURGERY*

Abstract

THE two chief manifestations of Graves' disease are hyperplastic goiter with hyperthyroidism and exophthalmos, the onsets of which usually are simultaneous. However, exophthalmos sometimes is the only manifestation of the disease. We consider Graves' disease to be the result of thyroidpituitary dysfunction. Exophthalmos that occurs in patients having Graves' disease is characterized not only by proptosis but also by various associated changes-These changes include retraction of the eyelids and manifestations resulting from increase in bulk of periocular tissues. This increase in bulk is caused by increases in the amount of fat and of mucopolysaccharides, and by an edema that has been proved not to be associated with an excess of water in the tissues (1, 2). The extraocular muscles become enlarged and infiltrated with fat and lymphocytes; eventually they become paralyzed and fibrosed. The proptosis may be extreme, with slight swelling of the lids and conjunctiva. Troublesome symptoms usually include a burning sensation of the eyes, pain, lacrimation, and diplopia (most commonly on upward gaze).