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Graves’ ophthalmopathy

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The ocular complications of Graves’ disease in adults are well described but there is a relative poverty of information about children. Ophthalmologists in Hong Kong (

) have described their findings in 83 children with Graves’ disease.

There were 72 girls and 11 boys all under 16 years. The mean age of onset of Graves’ disease was 9.5 years and mean duration of follow up at the time of ophthalmic examination 51 months. All patients were treated with oral antithyroid medication. Sixteen children had a first degree family history of thryotoxicosis.

Twelve of the 83 children had eye symptoms which included pain, sensation of a foreign body, photosensitivity, epiphora, and diplopia. Fifty-two (63%) had signs of ophthalmopathy although it was never severe enough to threaten vision and no child had debilitating ocular myopathy. Thirty-two children had lower lid retraction. Other signs included mild proptosis (10) lagophthalmos (8), lid lag (5), lid oedema (5), and upper lid retraction (4). Four had diffuse conjunctival injection. Only one patient had limited extraocular motility in extreme gaze. Eleven patients had punctate corneal epithelial erosions shown by fluorescein staining.

This is the largest series so far described of children with Graves’ disease and ocular complications. Although two thirds of patients had signs of eye disease they were usually mild.

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