Buschmann W
Klin Monbl Augenheilkd. 1986 Feb;188(2):138-40. doi: 10.1055/s-2008-1050598.
Elevated intraocular pressure may be found in patients with Graves' disease if it is measured with gaze in the usual straight-ahead direction. In such cases the patient must be allowed to change his direction of gaze, and in particular to his individual "resting" direction of gaze. In pseudoglaucoma IOP will normalize at once. If Graves' disease develops in addition it may become impossible to control existing primary glaucomas by drug therapy. Outflow from the aqueous veins may be impeded by congestion of the orbital veins and lymphatic pathways. It is thus recommended that effective treatment of Graves' disease be carried out first (surgical decompression of the orbit according to Buschmann and Richter if drug therapy fails to reduce the protrusion significantly). After removal of the protrusion and the orbital congestion, it may once again be possible to regulate IOP by drug therapy and glaucoma surgery may not be necessary. If, by contrast, glaucoma surgery is performed on an eye with persistent endocrine exophthalmos, this may result in a fatal progression of the compression in neuropathy of the optic nerve. This should be avoided. Exemplary case histories are discussed.
如果在格雷夫斯病患者向前直视时测量眼压，可能会发现眼压升高。在这种情况下，必须让患者改变注视方向，尤其是转向其个体的“静息”注视方向。在假性青光眼患者中，眼压会立即恢复正常。如果同时发生格雷夫斯病，可能无法通过药物治疗控制现有的原发性青光眼。眼眶静脉和淋巴通路的充血可能会阻碍房水静脉的流出。因此，建议首先对格雷夫斯病进行有效治疗（如果药物治疗不能显著减轻眼球突出，则根据布施曼和里希特的方法进行眼眶手术减压）。在消除眼球突出和眼眶充血后，可能再次能够通过药物治疗调节眼压，而不一定需要进行青光眼手术。相反，如果对患有持续性内分泌性眼球突出的眼睛进行青光眼手术，可能会导致视神经病变压迫的致命进展。应避免这种情况。文中讨论了典型病例。
