Ocular Involvement in Graves' Disease in Children: A Case Report

Abstract

Graves’  disease in children is considered rare, these children can present ocular attacks related to this pathology .We report the case of a girl presenting an exophthalmia complicated by corneal attack in the framework of a graves' disease. Our 6-year-old patient was admitted to the emergency room with bilateral exophthalmos associated with fluid diarrhea and palpitations. The ophthalmological examination revealed: bilateral exophthalmos more accentuated on the left side with palpebral retraction and a heart rate of 160 beats per minute. The diagnosis of Graves' disease was confirmed by thyroid receptor antibodies. The patient was put on: 40 mg of propanolol and 15 mg of carbimazole per day, with good clinical evolution, later the patient reconsulted for painful red eye with visual acuity decrease in left eye. The examination showed the presence of epithelial erosions with a rupture time lower than 5 seconds. The evolution was marked by a clinical improvement under lubricants and vitamin A. Graves' orbitopathy reacts differently between adults and children on the one hand, and between different ethnic groups on the other hand. It is more benign in children in the form of palpebral damage in most cases, unlike other manifestations such as nerve dysfunction and restrictive strabismus. We insist on the interest of lubricating treatment during palpebral retractions and lagophthalmos A find to avoid exposure keratitis.