Diplopia in Graves Disease

Abstract

In view of our inability to reverse the orbital pathology of Graves disease, clinical experience has shown us that it is prudent to defer, insofar as possible, the surgical repair of the residual pathology until the disease is stable. Towards this end, we have found the orthoptic evaluation to be an invaluable objective analysis which produces quantitative data and is a sensitive indicator of active orbitopathy. We have found, and would like to emphasize that prism therapy in those cases in which the deviation is minimal may create sufficient fusion in the primary and reading positions to obviate the need for surgery. As the disease progresses, it is a simpler matter to change a Fresnel prism than to force a monocular state or to operate repeatedly. The use of prisms postoperatively gives a higher degree of patient satisfaction and limits the number of reoperations.

The key to strabismus surgery in the setting of Graves disease is to delay surgery as long as possible until all data indicates the disease is stable, recess muscles more than one would do for other strabismus cases in view of the undesireability of resecting the antagonist, use supplementary prisms when tolerated and be prepared to accept at least one field of residual diplopia.

• Graves Disease
• strabismus
• strabismus surgery
• diplopia
• prism therapy