Evaluation of the Features of Graves’ Ophthalmopathy in Juvenile Graves' Disease

Abstract

The aim of our study was to evaluate the features of Graves’ ophthalmopathy in juvenile Graves disease.

Objectives: To identify the signs of Graves’ ophthalmopathy in juvenile patients with Graves’ disease.

Methods: The retrospective study was done at the Lithuanian University of Health science Kaunas Clinic of Eye diseases outpatient department. We reviewed the electronic medical records of all patients with Graves‘ Disease (GD) seen at the Clinic of Eye diseases, selecting 130 total patients, the age at diagnosis of GD, patients age was 17 (4.4-29.3) years. All patients had undergone a full ophthalmologic exam, including visual acuity, CAS, exophthalmometry with Hertel mirror exophthalmometer, biomicroscopy and ophthalmoscopy.

The statistical analysis was performed using the following softtware program package „SPSS for Windows“ (SPSS Inc., Chicago, IL, USA). The level of statistical significance was set at p<0.05 for all the tests.

Results: Of the total 130 patients with GD, 92 had no evidence of Graves’ Ophthalmopathy (GO-) and 38 had Graves’ Ophthalmopathy (GO+). When comparing the development of Graves’ Ophthalmopathy in patients with Graves’ disease by gender, we found that in both (GO+ and GO-) groups, there were statistically significantly more females than males (76.3/23.7% in the GO +group and 91.3/8.7% in the GO- group, p < 0.05). The study found that 38 patients with Graves’ disease had ocular changes characteristic of Graves’ Ophthalmopathy. The most common patient’s complaints were bulging of eyes (76.3%) and symptoms which are characteristic of dry eye syndrome (eye grittiness – 42.1%, tearing – 42.1% and photophobia – 31.6%). In the Graves’ ophthalmopathy group, the most common specific signs were upper eyelid retraction (73.7%) and Graefe’s symptom (47.4%). As non-specific, clinical symptoms of activity, showing 42.1 % of cases, hyperemia of conjunctivae (42.1%), carunculal redness (23.7%) were observed. The clinically active form (CAS was more than 3 points out of 7) was observed in 8 (21.1%) GO+ patients. 8 (21.1%} patients had impaired eye movements, but eye movements were limited only to the lateral side. There were no color sensitivity disorders in GO+ patients.

Conclusion: The most common patient’s with Graves’ Ophthalmopathy complaints were bulging of eyes and symptoms which are characteristic of dry eye syndrome (eye grittiness, tearing and photophobia). In this group of patients the most common specific signs were upper eyelid retraction and Graefe’s symptom. As non-specific, clinical symptoms of Graves’ Ophthalmopathy activity were hyperemia of conjunctivae, carunculal redness.