[Glaucoma in endocrine exophthalmus].

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.