The Pathologic Changes in the Orbit in Progressive Exophthalmos, with Special Reference to Alterations in the Extra-Ocular Muscles and the Optic Discs.

Abstract

We have seen a number of patients suffering from progressive exophthalmos following thyroidectomy, in each of whom careful study revealed many findings of ophthalmologic interest. For these patients a surgical treatment was devised which, in six instances, was highly satisfactory. In each, a similar mechanism for the exophthalmos was found, and the pathologic changes responsible for this disorder were proved. The usual development of the condition is as follows: Thyroidectomy is performed on a patient with exophthalmic goiter who presents the usual elevated basal metabolic rate and cardiovascular and nervous manifestations. Clinical improvement follows, except that the exophthalmos does not disappear. In a variable period, often in three or four months, it becomes evident that the proptosis is increasing. As it proceeds an increased fulness of the lids is noted ; then lacrimation and epiphora appear. A watery appearance of the scleral conjunctiva is followed first by edema near