Topical Guanethidine Therapy for Endocrine Lid Retraction

Abstract

Lid retraction, Dalrymple's sign, is one of the very common eye signs of Graves' disease often occurring after therapy has restored the euthyroid state as well as during the initial thyrotoxic attack. It may be unilateral or bilateral, symmetrical or asymmetrical. Exophthalmos may exist, but is not necessarily present. In addition to being a very troublesome cosmetic problem, lid retraction results in conjunctivitis and keratitis secondary to exposure and dehydration. Prolonged, untreated retraction may eventually lead to corneal ulceration and permanent scarring. Recently a new surgical approach for correction of lid retraction has been described.¹ In 1964² it was reported that one drop of a 10% guanethidine solution instilled in the eyes of normal patients caused a partial Horner's syndrome consisting of miosis, ptosis, and slight conjunctival vascular dilatation in the treated eye. Other ocular and systemic side effects were absent. Similarly, in 1961,³ no adverse side