ESCRS - P179 - CORNEAL INVOLVEMENT IN PAEDIATRIC GRAVES OPHTHALMOPATHY

CORNEAL INVOLVEMENT IN PAEDIATRIC GRAVES OPHTHALMOPATHY

Published 2022 - 26th ESCRS Winter Meeting

Reference: P179 | Type: Abstracts | DOI: 10.82333/xppr-9q26

Authors: Imad Messafi* 1 , Siham CHARIBA 1 , Asmae MAADANE 1 , Rachid SEKHSOUKH 1

1Ophthalmology,Mohammed VI University Hospital,Oujda,Morocco

Purpose

Graves disease is an autoimmune disorder characterized by the presence of pathogenic antibodies (thyroid receptor antibodies or ‘TRAb’, stimulating the thyroid gland directly through the TSH-receptor (TSHR). The diagnosis of GD is based on clinical signs of hyperthyroidism, thyroid function tests, and the presence of thyroidstimulation autoantibodies .The principal ocular symptoms are eye irritation , foriegn body sensation ,excessive tearing that is often made worse discomfort or pain, blurred vision, binocular diplopia. Even if vision threathening manifestations seems to be rare among this population (optic nerve alteration, strabismus), attention should be given to cornea leading to vision loss.

Setting

Ophthalmology department, Mohammed VI university hospital, Oujda, Morocco 

Methods

we report the case of a paediatric patient presenting reccurent corneal erosions due to Graves disease.

Results

A girl of 6 years old , the first child of two , born from an consanguineous marriage, was admitted initially in the paediatric emergencies for a bilateral exophtalmos associated with a cervical mass, irritability and nervousness associated with liquid diarrehea , night sweats and palpitations. The diagnosis of Graves disease was confirmed by anti-bodies dosing and she was ttreated 40 mg of propanolol and 15 mg of carbimazol per day , with a decreasing heart rate to 120 bpm and regression of the general symptomatology.Two weeks later, she was admitted complaining of red painful eyes with blurred vision. Examination revealed a bilateral exophtalmos with retraction of the superior and inferior eyelids , blepharospasm , a connjunctival injection eye with presence of epithelial erosions with a break-up time inferior to 5 seconds. Motility and fundus examination were normal. The evolution was favourable under medical treatement consistent of artificial tear drops and vitamin A ointement. 

Conclusion

Recent series are giving intrest to the corneal complications. 11 patients were found to have corneal complications by Chan and al .Hopefully, the manifestations consisted only of mild punctate epithelial erosions. These constatations are explained by the high frequency of lid retraction and lagophtalmos. It can be easily managed with lubricating eye drops and euthyroidism. Treatment should mostly be kept even if the graves disease is inactif , to prevent exposure keratopathy .To conclude , ocular manifestations in the Graves disease can be common in paediatric population. Even if they are less severe than in adults, our attention should be attracted through this case to the issue of eye dryness and surface alterations, that can only requiere eye drops ,and which can have an evolutive potential , that may lead to vision loss. a pedaetrician and ophthalmologist cooperation is crucial.