IRRADIATION OF THE PITUITARY IN THE TREATMENT OF MALIGNANT EXOPHTHALMOS

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Abstract
PROGRESSIVE protrusion of the eyes may occur in the presence of severe or mild thyrotoxicosis, after successful treatment of this toxic state, or in patients exhibiting no evidence of thyroid disease. This progressive exophthalmos may be spontaneously or artificially interrupted before any other eye signs or symptoms develop. If further progression of the exophthalmos occurs, however, certain accessory signs and symptoms may appear which characterize the clinical picture of “malignant exophthalmos.” These features have been described by Mulvaney (1) and others (2–4). The initial symptoms are usually orbital, retro-orbital, or frontal pain; burning; lacrimation; photobia; and, less commonly, diplopia. The eyes become obviously proptosed. The lids swell. Edema fluid appears under both bulbar and palpebral conjunctivae. These conjunctival sacs may protrude between the lids in transverse bands or hang down over the cheeks for a distance of several centimeters. The palpebral aperture may increase in size. When the patient loses his ability to close the eyes at night while asleep, the conjunctiva tends to dry. Exposure keratitis, corneal ulceration, panophthalmitis, surgical loss of the orbit, or, rarely, death from meningitis may then follow (3).

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