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14 Cards in this Set
- Front
- Back
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What are the clinical opthalmological signs of active TED?
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1. Lid odema (0-1)
2. Lid injection (0-1) 3. Conj injection (0-2) 4. Conj chemosis (0-2) 5. Pain on movement (0-1) 6. Pain at rest (0-1) 4 or more implies active disease |
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What is this 'Scoring System' of ACTIVE TED, called?
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Modified MOURITS score
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What are the poor prognostic factors for TED?
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1. Age: older- worse prognosis
2. Race: Asian - higher incidence of optic neuropathy 3. Nature of disease: Acute onset- worse prognosis 4. Thyroid function: a. Hyper or hypo on bloods: worse B. Pretibial myxoedema: worse C. High autoantibody levrls: worse 5. Smoking |
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What are the main features of the pathology in ACUTE TED?
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1. Hypertrophy of EOM. Due to accumulation of GLYCOSAMINOGLYCSNS
2. Incr inflam cells 3. Proliferstion of other tissues (fat, CT, Lacrimal gland) |
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What are the main pathological features of CHRONIC TED?
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1. Fibrosis of muscles
2. Increase in CHRONIC inflammatory cells |
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What are the blinding complications of TED?
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1. ON compression
2. Severe exposure keratopathy 3. Glaucoma (rare) |
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What are the extraocular features of TED?
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1. Proptosis
2. Lid: A. Lag B. Retraction C. Swelling D. Pigmentation 3. Restrictive myopathy |
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What are the intraocular features of TED?
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1. Ant Segment:
A. Conj injection B. Superior limbic keratitis C. Dry eyes D. Exposure keratopathy E. Epi/ scleritis F. Glaucoma 2. Posterior Seg A. Choroidal folds B. Macular odema C. ON swelling |
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How do you manage TED? (General)
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1. Team approach
2. Ocular tx dept on: - Activity disease - Thyroid status - Severity of ocular involvement |
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If surgery is indicated, what is the sequence?
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1. Orbital decompression
2. Strabismus surgery 3. Lid surgery |
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What are the general principles of ACTIVE disease management?
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1. Immunosuppression is the key
2. NSAIDS rarely effective 3. Tx of choice: high-dose pulsed ivi steroids 4. MTX can be used for long- term maint or if SE from steroids 5. Orbital radiation, if steroids C/I. |
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What is the treatment of choice in active TED?
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INTRAVENOUS steroids
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What alternative drug can be used if steroids have SE or are C/I?
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Methotrexate
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What else can be used if Steroids are C/I?
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Orbital radiation
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