Malignant Graves’ OphthalmopathyReportar como inadecuado

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Introduction: One of the most common causes ofhyperthyroidism is Graves’ disease. The malignant exophthalmos is a rare condition characterizedby the loss of visual function that doesn’t adequately respond to various formsof treatment, requiring, in most cases, surgical correction. Objective: We reporta case of conjunctival edema and protrusion of the eyeball in patients secondary to Graves’ disease, characterizing malignantophthalmopathy and discuss their surgical treatment. Case Report: A 73-year-old male patient presenting bilateralconjunctive hyperaemia, decreased visual acuity, exophtalmos with progressivedeterioration. Pulse therapy was performed without improvement and then underwent bilateralethmoidectomy. Discussion: Late diagnosis is harmful due to the fact that malignantdisease is extremely aggressive and fast, as reported in this case. Most often, the ophthalmopathyfollows a relatively mild and self-limiting course, making a proper diagnosis difficultif the disease progresses. In extreme cases acute orbital decompression is indicated complementing appropriatemedical treatment, which will allow herniation of orbital contents. Many orbitaldecompression techniques have been used in the treatment of Graves’ ophthalmopathy.The most common of these is the endoscopic sinus surgery which potentiated act indecompression of the medial wall safely and minimally invasive. In our case, openbilateral ethmoidectomy was used, due to the fact that surgeons are most experiencedin this technique. Although the post-operative has been successfully submitted,no signs of recurrence were observed after fifteen days due to theevolution of Graves’ disease. Even with outpatient treatment, he walked to the total visualloss. Conclusion: We observed that the malignant ophthalmopathy is rare and aggressive; however, in spite of therapeutic resources used,it can progress to total visual loss.

Autor: José Francisco de Salles Chagas, Jose Luis Braga de Aquino, Maria Beatriz Nogueira Paschoal, Luis Antonio Brandi Filho, Fernanda



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