Increased muscle tension and reduced elasticity of affected muscles in recent-onset Graves' disease caused primarily by active muscle contraction

Simonsz, Huib; Kommerell, Guntram

doi:10.1007/bf00153488

Cited by 20 publications

(12 citation statements)

References 6 publications

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“…As the increase was more pronounced in the early stages than in the late stages of TAO, it could be caused by an elevated eye muscle contractility that was described as a characteristic finding in inflammatory active TAO by Simonsz & Kommerell (1989). The authors found the contractile properties to be substantially altered in such individuals leading to a higher contractile activity.…”

Section: Discussionmentioning

confidence: 94%

Changes of saccadic eye movements in thyroid‐associated ophthalmopathy

Schworm¹,

Bolzani²,

Benassi³

et al. 2011

Acta Ophthalmologica

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ABSTRACT.Purpose: To establish whether or not the dynamics of saccadic eye movements are significantly changed in patients with different stages of thyroid-associated ophthalmopathy (TAO) and, subsequently, if analysis of saccades could serve as an additional diagnostic tool for early detection of inflammatory activity in TAO. Methods: Thirty-seven patients with TAO and 10 age-and gender-matched control subjects were investigated. The patients were divided into four groups according to the stage of the disease: (i) early mild disease (n = 10), (ii) early severe disease (n = 11), (iii) long-standing restrictive disease (n = 10) and (iv) proven auto-immune hyperthyroidism without any signs of TAO (n = 6). Horizontal and vertical saccades with amplitudes of 10°, 20°, 30°and 40°were recorded binocularly using the induction scleral search coil technique. The two main sequence constants V max and C were calculated for each eye. Repeated measurement analysis of variance was carried out to test for differences between different gaze directions, eyes and groups. Results: In horizontal saccades, significant differences were found between groups but not between abduction and adduction. In vertical saccades, differences between groups and the interaction between groups and up-and down-gaze saccades were significant. Compared with the control group, analysis of the main sequence curves revealed larger differences in patients of group 3 and 4 than in those of group 1 and 2. Whereas in the control group down-gaze saccades were faster than up-gaze saccades, the opposite behaviour was found in all patient groups. The largest differences were detected among those patients who had no signs of TAO (group 4). Conclusions: In this study, significant saccade differences were detected in all patients with TAO. In contrast to our earlier studies where evaluation of multiple individual saccade parameters did not reveal significant differences, analysis of the main sequence constants and mathematical reconstruction of the main sequence curves turned out to be a sensitive technique for reliable detection of subtle ocular motility changes. Significant differences were detected even in patients with auto-immune thyroiditis where no clinical signs of TAO were apparent.

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Section: Discussionmentioning

confidence: 94%

Changes of saccadic eye movements in thyroid‐associated ophthalmopathy

Schworm¹,

Bolzani²,

Benassi³

et al. 2011

Acta Ophthalmologica

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“…2003). Simonsz & Kommerell (1989) supplied evidence for the notion that, in the early stages of TAO, it is the contracture of eye muscles that creates increased stiffness, compared with normal eye muscle. Our results of increased steady‐state tension in patients with mild, active TAO might then be explained by increased muscle tonus but not by reduced elasticity from muscle inflammation and fibrosis, as in pronounced, active and longstanding, inactive TAO.…”

Section: Discussionmentioning

confidence: 99%

Eye muscle force development in thyroid‐associated ophthalmopathy in different stages of disease

Tian

Bolzani

Benassi

et al. 2007

Acta Ophthalmologica Scandinavica

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. Purpose: Ocular motility disturbances are common in patients with thyroid‐associated ophthalmopathy (TAO). A quantitative evaluation of the isometric force of the eye muscles in TAO might be useful in the detection of early stages of this disease. Methods: A total of 32 patients with TAO were divided into three groups according to whether they had mild active, pronounced, active, or longstanding, inactive disease. A group of six patients with Graves' disease without clinical signs of TAO and a group of 10 control subjects were also studied. The development of isometric force during saccadic eye movements of 5‐, 10‐ and 20‐degree amplitude in horizontal and vertical directions of gaze were recorded in the more affected eye in patients and the non‐dominant eye in normal subjects, using a suction contact lens/strain gauge technique. Results: Peak tension (Fp) in vertical and horizontal saccadic movements was not significantly different between groups. Steady‐state tension (Fs) was significantly higher in the groups with pronounced, active and longstanding, inactive disease than in the other groups for vertical (p < 0.01) and horizontal movements (p < 0.05). Abnormal force development in any of the gaze directions was seen in all patients with pronounced, active and longstanding, inactive TAO, and in some of the patients with mild, active TAO and Graves' disease without TAO. Conclusions: Increased eye muscle tension was recorded in different gaze directions, confirming multiple extraocular muscle involvement in TAO. It is suggested that the increased force development reflected contractile compensations for restrictions of ocular motility due to higher muscle stiffness in thyroid‐associated eye muscle disease. Tension measurements can be used to identify muscle involvement in TAO.

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“…The dose effect is higher in comparison to squint surgery for concomitant squint due to increased muscle tension and low elasticity in Grave's orbitopathy patients [ 22 ] (see Tables 21.1 and 21.2 ). Respecting the arc of contact, squint angles up to 15-17.5° (30-35 pdpt) can be corrected with a single inferior recession.…”

Section: Resulting In Hypotropiamentioning

confidence: 96%