Management

Reassurance is all that might be required in the mild forms of the disease. In some cases, treatment is usually limited to that of the exposure keratitis. Ocular lubrication with artificial tear drops, and an antibiotic ointment instilled at night is often sufficient. Sometimes a small lateral tarsorrhaphy on each side can greatly improve the appearance of a young girl with lid retraction. Lid retraction can also be improved by the use of guanethidine eye drops.

If there is visual deterioration (from optic nerve compression or significant proptosis), large doses of systemic steroids are probably the best line of treatment (e.g.,prednisolone 120 mg/ day). Initial recovery is usually dramatic and rapid but then the side effects of systemic steroids ensue. The dose should be reduced as soon as feasible but it might be necessary to continue with a maintenance dose for many months. Some ophthalmologists might use other immunosuppressive agents, such as azathio-prine, or orbital radiotherapy in severe cases of proptosis and/or optic nerve compression. If there is no response between 24h and 48 h, surgical decompression of the orbits is required. If double vision persists beyond the acute stage, extra-ocular muscle surgery can be helpful and operations have also been designed to deal with lid retraction.

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