UPPER EYELID RETRACTION IN THE ABSENCE OF OTHER EVIDENCE FOR PROGRESSIVE OPHTHALMOPATHY IS ASSOCIATED WITH EYE MUSCLE AUTOANTIBODIES

We have studied 25 clinically euthyroid patients with eyelid lag and r etraction referred to thyroid/eye clinic for clinical and orbital imag ing evidence of extraocular eye muscle (EM) involvement, evidence of p rogressive ophthalmopathy and serum antibodies reactive with EM membra ne antigens in immunoblotting. Fourteen patients had Graces' hyperthyr oidism, 5 had Hashimoto's thyroiditis, and 6 had euthyroid Graves' dis ease. By carrying out orbital imaging we showed EM abnormalities in 10 of 23 patients (43%). Serum antibodies reactive with EM membrane anti gens were detected in 96% of patients. Antibodies reactive with a 64-k Da antigen were detected in 66% of patients, while those reactive with 35-, 55-, and 95-kDa antigens were found in 21, 33, and 25% of patien ts, respectively. Antibody prevalences compared to normals were signif icantly different (P < 0.005) only for the 64-kDa protein. The prevale nce and the degree of reactivity of 64-kDa antibodies were significant ly different in patients with abnormal EM compared to those with norma l EM at orbital imaging (P < 0.04 and P < 0.01, respectively). The res ults of this work suggest that in some patients inflammation of the ey elid muscles may be an isolated feature of ophthalmopathy and remains as the only sign of a ''subclinical'' eye disease in patients with thy roid autoimmunity. (C) 1995 Academic Press, Inc.