Parallax-free exophthalmometry: a comprehensive review of the literature on clinical exophthalmometry and the introduction of the first parallax-free exophthalmometer.

PURPOSE: To present the first parallax-free exophthalmometer design. BACKGROUND: Exophthalmometry is an important clinical tool. We provide a historic overview of clinical exophthalmometer designs, and we review current problems encountered in exophthalmometry. METHODS: We present a new and parallax-free exophthalmometer design that we have evaluated in 49 patients visiting our orbital clinic. RESULTS: The mean age of the patients was 49.8 years and 72% were female. The Pearson interobserver variation was 0.97, and 94% of the Hertel values measured by the two observers were within the limits (1.6 mm) of agreement. CONCLUSION: This meter appears to be a reliable instrument for exophthalmometry. It is the first instrument that allows for a complete parallax-free measurement.

The philosopher Socrates had exophthalmos (a term coined by Plato) and probably Graves' disease.

According to a previously published theory, Socrates was afflicted with temporal lobe epilepsy since his childhood. Plato, Xenophon, and Aristoxenus described Socrates as having exophthalmos, probably diplopia, and some symptoms compatible with hyperthyroidism. Using these data, we theorize that Socrates had Graves' disease. In order to determine a cause of his temporal lobe epilepsy, we speculate that the philosopher also had autoimmune thyroiditis and Hashimoto encephalopathy during his childhood and his epilepsy may have been a sequel to this hypothesized encephalopathy.

Oskar Hirsch and surgery for exophthalmos.

Despite a better appreciation of the relationship between the eye and the thyroid gland in Graves' disease, the treatment of moderate to severe exophthalmos remains surgical. For many years, standard textbooks recommended a risky, transfrontal approach for exophthalmos that had to be performed by a neurosurgeon. A preferable transantral procedure, which can be performed by a plastic surgeon, was originally described by Oskar Hirsch, a Viennese otorhinolaryngologist, in 1930. Although his technique offers the advantage of causing less morbidity, it was several decades before its merits were widely recognized by practitioners.

Hyperthyroidism, exophthalmos, and goiter: historical notes on the orbitopathy.

BACKGROUND: Exophthalmos associated with goiter and/or symptoms of hyperthyroidism have been known since antiquity. It was not until around 1800 that a number of studies described this disorder in more detail. SUMMARY: For many years the nature of the disease remained unclear and it was appreciated as either a cardiac or neurological disease. There was no agreement on treatment. Surgery on the thyroid, orbit, autonomous nerve system, and pituitary has been employed. Medical treatment was introduced around World War II. Later, as a consequence of the discovery of long-acting thyroid stimulator, it became apparent that Graves-Basedow's disease was an autoimmune disease and so was the exophthalmos, though many details of the pathophysiology remain in doubt. CONCLUSIONS: This article presents a brief review of the history of the exophthalmos associated with thyroid disease.

La oftalmopatía tiroidea de Miguel Hernández Gilabert / Thyroid ophthalmopathy of Miguel Hernández Gilabert

No disponible

The large eyes of Wolfgang Amadeus Mozart. (On the occasion of the 250th Mozart anniversary year).

This article discusses the eyes of Wolfgang Amadeus Mozart (1756-1791) which, based on portraits, can be said to have a certain noticeable feature--some degree of exophthalmos. In fact, even contemporary observers made particular mention of Mozart's eyes being large. Although cicatricial ectropion, caused by infectious disease, cannot be excluded, mild myopia, in combination with shallow orbits or combined with a genetic predilection, would be one possible explanation for Mozart's large eyes. Graves' orbitopathy, the ophthalmic manifestation of hyperthyroidism, or hypothyroidism have both been suggested to be the cause of Mozart's large eyes. However, these diseases are unlikely causes given their topical and systemic features.