Alterações oftalmológicas na Doença de Graves: análise de 169 casos

Ophthalmic abnormalities in Graves' Disease: 169 cases report

RESUMO

Os propósitos desse estudo são: reportar as alterações oftalmológicas mais prevalentes na Doença de Graves, discutir alguns pontos controversos sobre os achados clínicos das alterações oculares, e demonstrar a necessidade de acompanhamento oftalmológico desses pacientes.

Para avaliar os pacientes com oftalmopatia, idealizou-se um protocolo que visa padronizar o atendimento em uma primeira consulta, - avaliando os principais sintomas ou sinais. Os dados foram analisados através do método do qui-quadrado. Cento e sessenta e nove pacientes portadores de oftalmopatia foram examinados. A idade variou entre 04 a 82 anos (36,23 ± 13,16) sendo que a maioria dos pacientes eram brancos (89,1%) e do sexo feminino (77,57%). A principal queixa relatada foi sensação de corpo estranho (63,03%). Cento e cinqüenta (90,9%) pacientes apresentaram acuidade visual (AV) de 20/25 ou melhor em pelo menos um dos olhos após correção óptica. Cento e oito (66,26%) tiveram alguma alteração de motilidade ocular ou retração palpebral. Setenta e nove (47,88%) pacientes apresentaram alteração na exoftalmometria em pelo menos um dos olhos, sendo geralmente bilateral. Ceratite puntata foi encontrada em 77 (46,66%) pacientes. Somente 12 (7,27%) apresentaram pressão intra-ocular (PIO) elevada (maior que 20 mmHg) e 4 (2,42%) apresentaram alterações de FO. Alteração da motilidade ocular, proptose e alterações corneanas foram os achados mais freqüentes. Baixa acuidade visual, dor ocular e sensação de corpo estranho foram os principais sintomas. Demonstrou-se a necessidade do exame oftalmológico nesses pacientes, mesmo naqueles sem hipertireoidismo no momento do exame, sendo que o estado clínico bem como o sexo e raça (p>0,05) não se relacionaram com os achados oculares, exceto a exoftalmia menos prevalente na raça negra (p<0,05).

Palavras-chave:
Doença de Graves; Oftalmopatia de Graves; Achados oculares; Avaliação clínica; Diagnóstico precoce

SUMMARY

The purposes of this study are to report the most frequent ophthalmologic findings in Graves’ Disease, discuss some controversial standpoints due to clinical findings of ocular abnormalities and prove the neccessity of ophthalmic exam in these patients. We established a protocol to better evaluate the patients with ophthalmopathy in order to standardize the first ophthalmic exam in these patients, evaluating the main signs and symptoms. The results were analysed using the qui-square method. One hundred and sixty nine patients with Graves'

Ophthalmopathy between the ages of 04 and 82 (36.23 ± 13.16) were examinated. The most part of patients were white (89.1%) and female (77.56%). The main complain was foreign body sensation (63.03%). One hundred and fifty (90.9%) patients had 20/25 visual acuity (VA) or better in the best eye after optic correction. One hundred and eight (66.26%) had ocular motion limitation or lid retraction. Seventy nine (47.88%) had alterations in the exophthalmometry at least in one eye. Stippling of cornea was found in 77 (46.66%) patients. Twelve (7.27%) had raised intraocular pressure (lOP) only, and 4 (2.42%) fundus abnormalities. Ocular motion alteration, proptosis and cornea alterations were the main signs. Poor visual acuity, ocular pain and foreign body sensation were the most frequent symptoms. We proved that is necessary an early ophthalmic exam in these patients, including the patients who did not have hyperthyroidism in the moment of ocular exam. Clinical stage and differences of sex and race (p>0.05) were not related to ocular findings, except proptosis which was less in the black people group (p<0.05).

Key-words:
Graves' Disease; Graves' Ophthalmopathy; Ocular findings; Clinical evaluation; Early diagnosis

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• Trabalho desenvolvido no ambulatório de oftalmologia do Hospital das Clínicas de Curitiba HC-UFPR.

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Datas de Publicação

• Publicação nesta coleção
  Oct 1997