An osteopathic approach to Graves’ ophthalmopathy: A case report

Grave's ophthalmopathy (GO), also known as Basedowian ophthalmopathy, is common and present in about 25–50% of Graves' disease patients. Graves' disease is an autoimmune disorder leading to excess thyroid hormone production. Patients may present with exophthalmos, periorbital edema, eyelid retraction, and, in severe cases, compression of the optic nerve. GO results in part from an inflammatory response that leads to fibroblast proliferation and congestion of local lymphatics. Treatment options for GO range from watchful waiting to surgical intervention and the treatment choice is determined by the severity of the patient's symptoms. All of the treatments have varying levels of success and many patients develop permanent exophthalmos despite treatment. This case study describes the osteopathic manipulative treatment (OMT) protocol for a 44-year-old male who presented with mild unilateral GO to the Osteopathic Treatment Center. To target all the components of the ophthalmopathy, a variety of OMT techniques were employed targeting the bones of the orbit and the overlying soft tissues. Our patient not only had improvement in reduction of periorbital edema after each treatment, but also showed decreased proptosis, measured by an exophthalmometer. Our study suggests that the use of OMT targeted to the structures of the orbit is effective in reducing the ophthalmopathy-associated symptoms of Graves' disease.