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ETIOLOGY OF EXOPHTHALMOS: CONSTITUTIONAL FACTORS, WITH PARTICULAR REFERENCE TO EXOPHTHALMIC GOITER

ETIOLOGY OF EXOPHTHALMOS: CONSTITUTIONAL FACTORS, WITH PARTICULAR REFERENCE TO EXOPHTHALMIC GOITER Abstract Abnormal protrusion of the eyeball is encountered in a wide variety of both local and general conditions. This article is devoted to constitutional diseases in which exophthalmos appears as either a complication or a part of the general abnormality. A certain amount of overlapping exists, because much of the exophthalmos which is encountered in general disease depends on the local accumulation in the orbit of tumors, hematomas or other masses, on the production of stasis in the orbital veins or on edema of the orbital tissues, all of which may result in forward dislocation of the eyeball. This generalization at times applies to the exophthalmos of exophthalmic goiter, which will be considered presently. It is partly, often wholly, applicable to the exophthalmos that occurs occasionally in other constitutional abnormalities. EXOPHTHALMOS IN DISEASES OTHER THAN EXOPHTHALMIC GOITER Exophthalmos is rare in syphilis. Delord1 described bilateral protrusion of the eyes References 1. Delord, Emile: Sur un cas d'exophthalmie bilatérale considérable par lésions de la région hypophysaire; guérison par le traitement mercuriel associé à la radiothérapie profonde , Arch. d'opth. 49:799 ( (Dec.) ) 1932. 2. Löhlein, Walther: Repetitorium der Augenheilkunde: VI. Exophthalmus und Enophthalmus , Deutsche med. Wchnschr. 56:663 ( (April 18) ) 1930. 3. Key, B. W.: A Case of Trichinosis with Exophthalmos , Am. J. Ophth. 12:178 ( (March) ) 1929. 4. Holström, M.: Zwei Fälle von Exophthalmus bei Neurofibromatosis Recklinghausen , Acta ophth. 6:403, 1928.Crossref 5. Benedict, W. L.: Personal communication to the authors. 6. Reese, A. B., and Guy, Loren: Exophthalmos in Leukemia , Am. J. Ophth. 16:718 ( (Aug.) ) 1933. 7. Mesropyan: Bilateral Exophthalmos in Monocytic Leukemia , Sovet. vestnik oftal. 1:558, 1932. 8. Rainess, L.: Eye Symptoms in Rachitis , Arch. Pediat. 47:55 ( (Jan.) ) 1930. 9. Yudkin, A. M.; Farquhar, Lucille, and Wakeman, A. J.: Some Abnormalities in Rats Subsisting on Diets Poor in Mineral Nutrients , Arch. Path. 17: 40 ( (Jan.) ) 1934. 10. Dunnington, J. H.: Exophthalmos in Infantile Scurvy , Arch. Ophth. 6: 731 ( (Nov.) ) 1931.Crossref 11. Krukow, cited by Dunnington.10 12. Barker, L. F., and Hanes, F. M.: Exophthalmos and Other Eye Signs in Chronic Nephritis , Am. J. M. Sc. 138:469 ( (Oct.) ) 1909.Crossref 13. Thayer, W. S., in discussion on Barker, L. F., and Hanes, F. M.: Exophthalmos and Other Eye Signs in Chronic Nephritis , Tr. A. Am. Physicians 24: 165, 1909. 14. Plummer, H. S.: Functions of the Normal and Abnormal Thyroid Gland: Histology of the Normal Thyroid , in Christian, H. A., and Mackenzie, J.: Oxford Medicine , New York, Oxford University Press, 1920, vol. 3, p. 846. 15. Müller, Heinrich, quoted by Landström.16 16. Landström, John: Ueber Morbus basedowii ; eine chirurgische und anatomische Studie , Stockholm, P. A. Norstedt & Söner, 1907. 17. MacCallum, W. G., and Cornell, W. B.: On Mechanism of Exophthalmos , M. News 85:732 ( (Oct. 15) ) 1904. 18. The Mechanism of Exophthalmos, Editorial , J. A. M. A. 102:2188 ( (June 30) ) 1934. 19. Holloway, T. B.; Fry, W. E., and Wentworth, H. A.: Ocular Signs in One Hundred Unselected Cases of Goiter , J. A. M. A. 92:35 ( (Jan. 5) ) 1929.Crossref 20. Labbé, Marcel; Villaret, Maurice; Justin-Besançon, L., and Schiff-Wertheimer: Recherches sur la pathogéne de l'exophthalmie Basedowienne et son traitement , Bull. Acad. de méd., Paris 110:730 ( (Dec.) ) 1933 21. Bull. et mém. Soc. méd. d. hôp. de Paris 47:1883 and 1897 ( (Dec. 21) ) 1931. 22. Kendall, L. C., and Haines, S. F.: Personal communication to the authors. 23. Kunde, M. M.: Studies on Metabolism: VI. Experimental Hyperthyroidism , Am. J. Physiol. 82:195 ( (Sept.) ) 1927. 24. Schochaert, J. A.: Enlargement and Hyperplasia of the Thyroids in the Young Duck from the Injection of Anterior Pituitary , Am. J. Anat. 49:379 ( (Jan.) ) 1932.Crossref 25. Loeb, L., and Friedman, H.: Exophthalmos Produced by Injections of Acid Extract of Anterior Pituitary Gland of Cattle , Proc. Soc. Exper. Biol. & Med. 29:648 ( (Feb.) ) 1932. 26. Marine, D., and Rosen, S. H.: Exophthalmos in Thyroidectomized Guinea-Pigs by Thyrotopic Substance of Anterior Pituitary, and Mechanism Involved , Proc. Soc. Exper. Biol. & Med. 30:901 ( (April) ) 1933. 27. Friedgood, H. B.: The Ocular Manifestations of Sympathetic Nervous System; Hyperactivity in Conditions Other Than Exophthalmic Goiter and Especially in Essential Hypertension ; "Lidspasm": A New Eye Sign , Am. J. M. Sc. 180:836 ( (Dec.) ) 1930 28. Experimental Exophthalmos and Hyperthyroidism in Guinea-Pigs: Clinical Course and Pathology , Bull. Johns Hopkins Hosp. 54:48 ( (Jan.) ) 1932. 29. Joll, C. A.: Diseases of the Thyroid Gland with Special Reference to Thyrotoxicosis , St. Louis, C. V. Mosby Company, 1932. 30. Boothby, W. M.: The Thyroid Problem, Collected Papers of the Mayo Clinic , Philadelphia, W. B. Saunders Company, 1928, vol. 20, p. 495. 31. Barker, L. F.: The Diagnosis of Exophthalmic Goiter , J. A. M. A. 49: 1235 ( (Oct. 12) ) 1907.Crossref 32. The grading of exophthalmos in these cases was based on inspection alone. The examiners, however, were physicians who had been trained to distinguish true prominence of the bulb from apparent prominence resulting from retraction of the eyelids. There is no reason to believe that the percentage of error in series as large as these would change ; therefore, the grading that was done after 1930 can be assumed to be the same as the grading done before 1922. 33. Bulson, A. E., Jr., in discussion on Thayer, W. S.: Ocular Symptoms in Ophthalmic Goiter , Tr. Sect. Ophth., A. M. A. 1926, p. 56. 34. Zimmerman, L. M.: Exophthalmos Following Operation for the Relief of Hyperthyroidism , Am. J. M. Sc. 178:92 ( (July) ) 1929.Crossref 35. Thompson, E. S.: Orbital Edema in Exophthalmic Goitre , Am. J. Ophth. 7:27 ( (Jan.) ) 1924. 36. Haines, S. F.: Exophthalmic Goiter and Myxedema: Report of a Case , Endocrinology 12:55, 1928.Crossref 37. Burch, F. E.: The Exophthalmos of Graves' Disease , Minnesota Med. 12: 668 ( (Nov.) ) 1929. 38. Roeder, C. A.: A Third Type of Toxic Thyroidism , Northwest Med. 29: 395, 1930. 39. King, B. T.: The Cause of Exophthalmos , West. J. Surg. 39:602 ( (Aug.) ) 1931. 40. Naffziger, H. C.: Pathologic Changes in the Orbit in Progressive Exophthalmos , Arch. Ophth. 9:1 ( (Jan.) ) 1933.Crossref 41. Naffziger, H. C., and Jones, O. W., Jr.: The Surgical Treatment of Progressive Exophthalmos Following Thyroidectomy , J. A. M. A. 99:638 ( (Aug. 20) ) 1932.Crossref 42. Benedict, W. L., cited by Pemberton. 43. Foster, M. R.: Exophthalmos and Limitation of the Eye Movements of Graves' Disease , Lancet 2:701, 1920.Crossref 44. O'Leary, P. A.: Localized Solid Edema of the Extremities in Association with Exophthalmic Goiter , Arch. Dermat. & Syph. 21:57 ( (Jan.) ) 1930. 45. O'Day, J. C.: Syphilis in the Rôle of Malignant Neoplasms , New York M. J. 100:1258 ( (Dec. 26) ) 1914. 46. Wilson, L. B.: Personal communication to the authors. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

ETIOLOGY OF EXOPHTHALMOS: CONSTITUTIONAL FACTORS, WITH PARTICULAR REFERENCE TO EXOPHTHALMIC GOITER

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American Medical Association
Copyright
Copyright © 1935 American Medical Association. All Rights Reserved.
ISSN
0003-9950
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1538-3687
DOI
10.1001/archopht.1935.00840050111011
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Abstract

Abstract Abnormal protrusion of the eyeball is encountered in a wide variety of both local and general conditions. This article is devoted to constitutional diseases in which exophthalmos appears as either a complication or a part of the general abnormality. A certain amount of overlapping exists, because much of the exophthalmos which is encountered in general disease depends on the local accumulation in the orbit of tumors, hematomas or other masses, on the production of stasis in the orbital veins or on edema of the orbital tissues, all of which may result in forward dislocation of the eyeball. This generalization at times applies to the exophthalmos of exophthalmic goiter, which will be considered presently. It is partly, often wholly, applicable to the exophthalmos that occurs occasionally in other constitutional abnormalities. EXOPHTHALMOS IN DISEASES OTHER THAN EXOPHTHALMIC GOITER Exophthalmos is rare in syphilis. Delord1 described bilateral protrusion of the eyes References 1. Delord, Emile: Sur un cas d'exophthalmie bilatérale considérable par lésions de la région hypophysaire; guérison par le traitement mercuriel associé à la radiothérapie profonde , Arch. d'opth. 49:799 ( (Dec.) ) 1932. 2. Löhlein, Walther: Repetitorium der Augenheilkunde: VI. Exophthalmus und Enophthalmus , Deutsche med. Wchnschr. 56:663 ( (April 18) ) 1930. 3. Key, B. W.: A Case of Trichinosis with Exophthalmos , Am. J. Ophth. 12:178 ( (March) ) 1929. 4. Holström, M.: Zwei Fälle von Exophthalmus bei Neurofibromatosis Recklinghausen , Acta ophth. 6:403, 1928.Crossref 5. Benedict, W. L.: Personal communication to the authors. 6. Reese, A. B., and Guy, Loren: Exophthalmos in Leukemia , Am. J. Ophth. 16:718 ( (Aug.) ) 1933. 7. Mesropyan: Bilateral Exophthalmos in Monocytic Leukemia , Sovet. vestnik oftal. 1:558, 1932. 8. Rainess, L.: Eye Symptoms in Rachitis , Arch. Pediat. 47:55 ( (Jan.) ) 1930. 9. Yudkin, A. M.; Farquhar, Lucille, and Wakeman, A. J.: Some Abnormalities in Rats Subsisting on Diets Poor in Mineral Nutrients , Arch. Path. 17: 40 ( (Jan.) ) 1934. 10. Dunnington, J. H.: Exophthalmos in Infantile Scurvy , Arch. Ophth. 6: 731 ( (Nov.) ) 1931.Crossref 11. Krukow, cited by Dunnington.10 12. Barker, L. F., and Hanes, F. M.: Exophthalmos and Other Eye Signs in Chronic Nephritis , Am. J. M. Sc. 138:469 ( (Oct.) ) 1909.Crossref 13. Thayer, W. S., in discussion on Barker, L. F., and Hanes, F. M.: Exophthalmos and Other Eye Signs in Chronic Nephritis , Tr. A. Am. Physicians 24: 165, 1909. 14. Plummer, H. S.: Functions of the Normal and Abnormal Thyroid Gland: Histology of the Normal Thyroid , in Christian, H. A., and Mackenzie, J.: Oxford Medicine , New York, Oxford University Press, 1920, vol. 3, p. 846. 15. Müller, Heinrich, quoted by Landström.16 16. Landström, John: Ueber Morbus basedowii ; eine chirurgische und anatomische Studie , Stockholm, P. A. Norstedt & Söner, 1907. 17. MacCallum, W. G., and Cornell, W. B.: On Mechanism of Exophthalmos , M. News 85:732 ( (Oct. 15) ) 1904. 18. The Mechanism of Exophthalmos, Editorial , J. A. M. A. 102:2188 ( (June 30) ) 1934. 19. Holloway, T. B.; Fry, W. E., and Wentworth, H. A.: Ocular Signs in One Hundred Unselected Cases of Goiter , J. A. M. A. 92:35 ( (Jan. 5) ) 1929.Crossref 20. Labbé, Marcel; Villaret, Maurice; Justin-Besançon, L., and Schiff-Wertheimer: Recherches sur la pathogéne de l'exophthalmie Basedowienne et son traitement , Bull. Acad. de méd., Paris 110:730 ( (Dec.) ) 1933 21. Bull. et mém. Soc. méd. d. hôp. de Paris 47:1883 and 1897 ( (Dec. 21) ) 1931. 22. Kendall, L. C., and Haines, S. F.: Personal communication to the authors. 23. Kunde, M. M.: Studies on Metabolism: VI. Experimental Hyperthyroidism , Am. J. Physiol. 82:195 ( (Sept.) ) 1927. 24. Schochaert, J. A.: Enlargement and Hyperplasia of the Thyroids in the Young Duck from the Injection of Anterior Pituitary , Am. J. Anat. 49:379 ( (Jan.) ) 1932.Crossref 25. Loeb, L., and Friedman, H.: Exophthalmos Produced by Injections of Acid Extract of Anterior Pituitary Gland of Cattle , Proc. Soc. Exper. Biol. & Med. 29:648 ( (Feb.) ) 1932. 26. Marine, D., and Rosen, S. H.: Exophthalmos in Thyroidectomized Guinea-Pigs by Thyrotopic Substance of Anterior Pituitary, and Mechanism Involved , Proc. Soc. Exper. Biol. & Med. 30:901 ( (April) ) 1933. 27. Friedgood, H. B.: The Ocular Manifestations of Sympathetic Nervous System; Hyperactivity in Conditions Other Than Exophthalmic Goiter and Especially in Essential Hypertension ; "Lidspasm": A New Eye Sign , Am. J. M. Sc. 180:836 ( (Dec.) ) 1930 28. Experimental Exophthalmos and Hyperthyroidism in Guinea-Pigs: Clinical Course and Pathology , Bull. Johns Hopkins Hosp. 54:48 ( (Jan.) ) 1932. 29. Joll, C. A.: Diseases of the Thyroid Gland with Special Reference to Thyrotoxicosis , St. Louis, C. V. Mosby Company, 1932. 30. Boothby, W. M.: The Thyroid Problem, Collected Papers of the Mayo Clinic , Philadelphia, W. B. Saunders Company, 1928, vol. 20, p. 495. 31. Barker, L. F.: The Diagnosis of Exophthalmic Goiter , J. A. M. A. 49: 1235 ( (Oct. 12) ) 1907.Crossref 32. The grading of exophthalmos in these cases was based on inspection alone. The examiners, however, were physicians who had been trained to distinguish true prominence of the bulb from apparent prominence resulting from retraction of the eyelids. There is no reason to believe that the percentage of error in series as large as these would change ; therefore, the grading that was done after 1930 can be assumed to be the same as the grading done before 1922. 33. Bulson, A. E., Jr., in discussion on Thayer, W. S.: Ocular Symptoms in Ophthalmic Goiter , Tr. Sect. Ophth., A. M. A. 1926, p. 56. 34. Zimmerman, L. M.: Exophthalmos Following Operation for the Relief of Hyperthyroidism , Am. J. M. Sc. 178:92 ( (July) ) 1929.Crossref 35. Thompson, E. S.: Orbital Edema in Exophthalmic Goitre , Am. J. Ophth. 7:27 ( (Jan.) ) 1924. 36. Haines, S. F.: Exophthalmic Goiter and Myxedema: Report of a Case , Endocrinology 12:55, 1928.Crossref 37. Burch, F. E.: The Exophthalmos of Graves' Disease , Minnesota Med. 12: 668 ( (Nov.) ) 1929. 38. Roeder, C. A.: A Third Type of Toxic Thyroidism , Northwest Med. 29: 395, 1930. 39. King, B. T.: The Cause of Exophthalmos , West. J. Surg. 39:602 ( (Aug.) ) 1931. 40. Naffziger, H. C.: Pathologic Changes in the Orbit in Progressive Exophthalmos , Arch. Ophth. 9:1 ( (Jan.) ) 1933.Crossref 41. Naffziger, H. C., and Jones, O. W., Jr.: The Surgical Treatment of Progressive Exophthalmos Following Thyroidectomy , J. A. M. A. 99:638 ( (Aug. 20) ) 1932.Crossref 42. Benedict, W. L., cited by Pemberton. 43. Foster, M. R.: Exophthalmos and Limitation of the Eye Movements of Graves' Disease , Lancet 2:701, 1920.Crossref 44. O'Leary, P. A.: Localized Solid Edema of the Extremities in Association with Exophthalmic Goiter , Arch. Dermat. & Syph. 21:57 ( (Jan.) ) 1930. 45. O'Day, J. C.: Syphilis in the Rôle of Malignant Neoplasms , New York M. J. 100:1258 ( (Dec. 26) ) 1914. 46. Wilson, L. B.: Personal communication to the authors.

Journal

Archives of OphthalmologyAmerican Medical Association

Published: May 1, 1935

References