Exophthalmos and Associated Ocular Disturbances in Hyperthyroidism

WHEN Marine and his associates1produced chronic progressive bilateral exophthalmos by daily intramuscular injections of 0.05 to 0.1 cc. of methyl cyanide in 2 to 3 month old rabbits maintained on a diet of alfalfa, hay and oats, he came to the following conclusion : Cyanides appear to act by inhibiting metabolic processes. This inhibition stimulates the hypothalamic centers which in turn, stimulate, the pituitary to produce the thyrotropic hormone, which in turn stimulates the thyroid gland and independently the sympathetic centers in the mid-brain, causing exophthalmos. It occurred to us that since pupillography, as devised by Lowenstein and associates,2can show evidences of central sympathetic disturbances, it might be advantageous to determine what these changes are which occur with hyperthyroidism. Accordingly, 22 patients were studied; these included patients with and without exophthalmos and patients with unilateral exophthalmos. The results were interesting (fig. 1). All but 1 patient showed