Severe Graves' Ophthalmopathy After Retrobulbar Anesthesia for Cataract Extraction in a Patient With Mild Stable Thyroid Eye Disease

Conclusions

We hypothesize that trauma/pressure in the retrobulbar space in this patient induced by the retrobulbar block triggered local inflammatory and immune responses, which in turn caused progression of thyroid eye disease. This is consistent with the prevailing concept that trauma and/or pressure explain, at least in part, the distribution of the extrathyroidal manifestations of Graves' disease. Second, orbital irradiation may occasionally be effective in the treatment of even severe ocular dysmotility if administered in the acute phase. Finally, the improvement of ophthalmopathy occurred despite TSI levels remaining markedly elevated suggesting that beneficial effects of radiotherapy are not mediated by suppressing TSI production.

Thyroid. 2003;13(8) © 2003 Mary Ann Liebert, Inc.