Diagnosis of exophthalmos using orbital ultrasonography and treatment of malignant exophthalmos with steroid therapy, orbital radiation therapy, and plasmapheresis.

For the quantitative analysis of the extraocular muscle changes in Graves' disease, we used B-mode ultrasonography. 113 patients investigated in this study had no signs or symptoms of ophthalmopathy except proptosis. Muscle index was calculated as a sign of extraocular muscle enlargement. Muscle index of Graves' disease was significantly larger than that in controls (6.03 +/- 2.83 and 3.10 +/- 1.29, respectively). The muscle index in Graves' patients without clinical signs of exophthalmos was significantly increased when compared to control subjects, although both groups had the same degree of proptosis. The data show a uniform enlargement of the extraocular muscles in Graves' disease. The degree of proptosis is in close proportion to the quantitative change of the orbital soft tissue. Seven patients with malignant exophthalmos were treated with steroid therapy, supervoltage orbital radiotherapy or plasmapheresis. All patients had moderately severe ophthalmopathy due to Graves' disease. Both steroid therapy and orbital radiation therapy were effective in improving the symptoms of orbital soft tissue involvement and for diplopia. The effect of orbital radiation therapy was insufficient for the amelioration of proptosis in spite of a no significant decrease. The improvement of proptosis was evident only after 3-7 months of the radiotherapy. Plasmapheresis was effective in improving the ulceration of cornea and proptosis, but this was a transient effect.