Sympathetic overactivity of intraocular muscles evaluated by accommodation in patients with hyperthyroidism

Selenium supplementation in inactive moderate to severe Graves' orbitopathy patients: a randomized controlled trial

PURPOSE

This study was designed to evaluate the effect of selenium supplementation in inactive moderate-severe Graves' orbitopathy (GO) patients.

METHODS

This study was a single-center, placebo-controlled, double-masked, randomized trial. Inactive moderate-severe GO participants were randomized to receive six months of 200 micrograms/day of selenium supplementation or placebo. Thorough eye exams, clinical activity score (CAS), Graves' Ophthalmopathy quality of life questionnaire (GO-QOL), and serum selenium level were evaluated at baseline and 6 months after the interventions. The chi-squared or Fisher's exact test was used to compare categorical variables. The t-test and the paired t-test were used to compare continuous variables between two independent samples and two dependent samples, respectively.

RESULTS

A total of 25 participants were enrolled, 13 in the selenium group and 12 in the placebo group. Both groups had adequate baseline serum selenium levels at 98.96 ± 15.63 mcg/L and 102.55 ± 17.71 mcg/L, respectively. After 6 months of intervention, the selenium group showed a greater improvement in palpebral aperture (mean difference: -1.4 ± 1.7 mm, p = .04) compared to the placebo group (-0.3 ± 2.7 mm). Notably, 5(41.67%) people in the placebo group developed larger palpebral apertures. Proptosis, ocular motility, and soft tissue signs did not change significantly. GO-QOL and CAS score improvement showed no statistically significant difference between both groups. Minor adverse effects were observed.

CONCLUSIONS

Selenium supplementation has a positive effect on eyelid aperture even in inactive moderate-to-severe GO patients with a sufficient baseline selenium level.

Management of eyelid retraction related to thyroid eye disease

Eyelid retraction related to thyroid eye disease (TED) is a challenging condition. It is one of the main clinical signs and a major diagnostic criterion in TED. This condition may threaten vision due to exposure keratopathy, in addition to its esthetic alterations, which may lead to psychosocial implications and affect the patient's quality of life. Although it is more commonly observed in the upper eyelid, it may be present on both the upper and lower lids. Numerous surgical and nonsurgical treatment modalities have been described and will be reviewed in this article. Management should be based on an individual patient assessment, taking into consideration the disease stage, severity, and clinician experience.

Association of sympathovagal imbalance with cardiovascular risks in overt hypothyroidism

Background:

Cardiovascular morbidities have been reported in hypothyroidism.

Aims:

The objective of this study is to investigate the link of sympathovagal imbalance (SVI) to cardiovascular risks (CVRs) and the plausible mechanisms of CVR in hypothyroidism.

Materials and Methods:

Age-matched 104 females (50 controls, 54 hypothyroids) were recruited and their body mass index (BMI), cardiovascular parameters, autonomic function tests by spectral analysis of heart rate variability (HRV), heart rate response to standing, deep breathing and blood pressure response to isometric handgrip were studied. Thyroid profile, lipid profile, immunological and inflammatory markers were estimated and their association with low-frequency to the high-frequency ratio (LF-HF) of HRV, the marker of SVI was assessed by multivariate regression.

Results:

Increased diastolic pressure, decreased HRV, increased LF-HF, dyslipidemia and increased high-sensitive C-reactive protein (hsCRP) were observed in hypothyroid patients and all these parameters had significant correlation with LF-HF. BMI had no significant association with LF-HF. Atherogenic index (β 1.144, P = 0.001) and hsCRP (b 0.578, P = 0.009) had independent contribution to LF-HF. LF-HF could significantly predict hypertension status (odds ratio 2.05, confidence interval 1.110-5.352, P = 0.008) in hypothyroid subjects.

Conclusions:

SVI due to sympathetic activation and vagal withdrawal occurs in hypothyroidism. Dyslipidemia and low-grade inflammation, but not obesity contribute to SVI and SVI contributes to cardiovascular risks.

Bilateral upper eyelid retraction caused by topical bimatoprost therapy

The authors report a case with upper eyelid retraction caused by topical bimatoprost therapy. Topical bimatoprost 0.03% was administered to a 69-year-old woman with bilateral normal-tension glaucoma. It was first administered to the left eye, and 3 weeks later, therapy on the right side of the eye was initiated. One week after the initiation of therapy on the right side, right upper eyelid retraction occurred, and 63 days after starting treatment on the left side (42 days after initiation on the right side), conspicuous bilateral upper eyelid retraction was observed. Bimatoprost instillation was then stopped and the medication was switched to latanoprost 0.005%. Upper eyelid retraction was reversed to normal levels approximately 1 week after cessation of bimatoprost therapy. In conclusion, a rare case of upper eyelid retraction caused by topical bimatoprost therapy, which was reversed after discontinuation of the medication, is reported.

Ophthalmic manifestations of endocrine disorders: approaches and medical management

PURPOSE OF REVIEW

Disorders of the endocrine system may present with various ophthalmic signs, symptoms, and pathology. Early detection, prevention, and monitoring of these manifestations can significantly benefit morbidity associated with such disease states including permanent visual dysfunction.

RECENT FINDINGS

Several studies highlight the importance of early diagnosis in reducing the long-term complications associated with these endocrine conditions, although these observations are mostly based on case reports and case series.

SUMMARY

This review will focus on the connection of endocrine-related disease states with the development of specific ophthalmic pathology and is geared towards the general medical practitioner. The focus of the treating physician should be on facilitating early diagnosis to prevent potentially blinding complications.

Extrathyroidal manifestations of thyroid disease: thyroid ophthalmopathy

Thyroid ophthalmopathy is a common autoimmune, inflammatory disease involving the orbit. Diagnosis is based on the clinical presentation and findings. Imaging, mainly CT and MR imaging, are helpful to reveal the extent of disease and degree of muscle enlargement and to evaluate for complications, such as optic nerve compression. This article reviews the basic pathology and pathophysiology of the disease and describes the extensive imaging findings on CT and MR imaging. The differential diagnosis of thyroid ophthalmopathy is reviewed.

Monocular involuntary eyelid closure

OBJECTIVES

Monocular blepharospasm (MBLS) is precipitated by ipsilateral ocular pathology and becomes bilateral over time. Two patients are reported with monocular visual disturbance exhibiting monocular involuntary eyelid closure (MIEC), resembling MBLS.

MATERIAL AND METHODS

A 31-year-old female with hyperthyroidism developed monocular polyopia with left eye vision on binocular fixation followed by ipsilateral visual extinction. Monocular vision was otherwise normal. A 57-year-old male with renal failure developed monocular blindness secondary to retinal hemorrhage.

RESULTS

The first patient had anisocoria and proptosis. Brain magnetic resonance (MR) was normal. The second patient had involuntary movements of the left eye. Head computerized tomography (CT) was normal. Both patients exhibited MIEC of the eye with visual impairment that could be overcome voluntarily, but reappeared upon distraction. Neither of the two developed BLS in long-term follow-up.

CONCLUSION

MIEC represents a complication of ipsilateral ocular pathology in the absence of other involuntary movements, apraxia of eyelid opening, or blepharospasm (BLS). MIEC needs to be distinguished from MBLS, since not all MBLS becomes bilateral.