Isolated Lacrimal Gland Enlargement in Thyroid-Related Orbitopathy

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Abstract

Thyroid-related orbitopathy (TRO) is considered to be an inflammatory autoimmune disorder that commonly presents with extraocular muscle and retrobulbar fat enlargement. Lacrimal gland enlargement in TRO has been reported in the past in association with other radiological findings. Our case represents an isolated lacrimal gland enlargement as a presenting radiological finding in an euthyroid patient showing elevation of thyroid-stimulating immunoglobulin. After ruling out possible pathologies such as a monoclonal process, lacrimal epithelial tumor, or a nonspecific orbital inflammation, the patient underwent orbital decompression, serial botulinum toxin injections, and upper eyelid-retraction surgical correction. After two years of follow-up, the patient developed new-onset diplopia; consequent imaging showed extraocular muscle enlargement which was not present on previous imaging.

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Most cited references 10

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Graves' ophthalmopathy.

Rebecca Bahn (2010)

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Graves orbitopathy: correlation of CT and clinical findings.

J Rootman, D A Graeb, Molly R Belkin … (1990)

The clinical and high-resolution computed tomographic (CT) findings in 71 patients (142 orbits) with Graves orbitopathy and 20 healthy patients (40 orbits) were retrospectively reviewed. The orbits with orbitopathy were subgrouped at clinical examination into those with (n = 18) and those without (n = 124) optic neuropathy. Mean extraocular muscle diameters and the calculated muscle diameter index were significantly increased in all orbits with ophthalmopathy, particularly in those with optic neuropathy. Graves orbitopathy affected the superior muscle group (63.4%) more than the medial (61.3%) or inferior (57%) recti. The most common pattern of muscle involvement involved all five measured extraocular muscles. Solitary muscle involvement most frequently involved the superior muscle group (6.3%). Significant enlargements of the retrobulbar optic nerve sheath and superior ophthalmic vein were noted only in orbits with optic neuropathy. Anterior displacement of the lacrimal gland at CT correlated with clinical palpability and occurred more frequently in patients with optic neuropathy. Severe apical crowding was the most sensitive indication of optic neuropathy at CT.

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Changes of lacrimal gland and tear inflammatory cytokines in thyroid-associated ophthalmopathy.

Danping Huang, Quan Luo, Huasheng Yang … (2014)

To explore changes in lacrimal gland and tear inflammatory cytokines in thyroid-associated ophthalmopathy (TAO) patients.

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Author and article information

Journal

Journal ID (publisher-id): COP

Journal ID (pmc): COP

Journal ID (doi): 10.1159/issn.1663-2699

Title: Case Reports in Ophthalmology

Publisher: S. Karger AG

ISSN (Electronic): 1663-2699

Publication date Subscription-year: 2021

Publication date Collection: January - April 2021

Publication date (Electronic): 12 April 2021

Volume: 12

Issue: 1

Pages: 142-145

Affiliations

[_a] _aDepartment of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel

[_b] _bDepartment of Radiology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel

Author information

Roee Arnon https://orcid.org/0000-0001-9995-8574

Article

Publisher ID: 514909 Other ID: Case Rep Ophthalmol 2021;12:142–145

DOI: 10.1159/000514909

PMC ID: 8077451

PubMed ID: 33976671

SO-VID: 9e28ac98-7ed0-4b94-9434-99a47b028cef

License:

This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 20 October 2020

Date accepted : 31 January 2021

Page count

Figures: 3, Pages: 4

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