Endocrine orbitopathyas seen at Kenyatta National Hospital

Abstract

This is a prospective study of endocrine orbitopathy carried out at hospital level in Kenyatta National Hospital in African patients over a period of 15 months from November 1986 - January 1988 inclusive. A total of 52 patients with thyrotoxicosis were seen. The age range was from 17 to 55 years. These included 6 male and 46 female patients. 40 of the patients seen had ocular involvement representing 76.9%. Of these, 8 patients had unilateral involvement while 32 had bilateral ocular involvement. 45 of the patients presented first to the medical clinic with systemic symptoms of hyperthyroidism: weight loss inspite of increased appetite, tachycardia, tremulousness heat intolorance, irritability and nervousness etc. before they were entered into the study. 7 patients presented initially to the eye clinic with complaints of protrussion of one or botll eyes. These were examined and later confirmed thyrotoxic [rom biochemical data. The commonest manifestations of endocrine orbitopathy were found to be lid oedema, lid retraction and lid lag, exophthalmos and extraocular muscle involment, mainly by way of ultrasonographically demonstrable muscle enlargement. One patient had diplopia, 2 patients had exposure keratitis, 3 patients had choroidal striae. 2 Visual acuity was normal in 102 eyes out of 104 studied. The other two eyes has visual acuity of 6/36 and 6/60. The decreasein visual acuity were mainly due to exposure keratitis and suspected dysthyroid optic neuropathy. 2 patients had medical decompression of the orbit with systemic steroids. 2 patients hnd tnrrsorhaphy performed for exposure keratitis. No patients had radiotherapy or surgical orbital decompression. No muscle surgery was performed. Minor symptoms like feeling of grittiness in the eyes, burning sensations etc. were treated with artificial tear substitutes. Correlation between orbitopathy and biochemical levels of T.S.H. and T3 and T4 was found to be poor. Some patients were hyperthyroid with no demonstrable ocular involvement while others were euthyroid after treatment with persistence of ocular manifestations.