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Show Editorial Comment Proptosis and Steroids In thi~ i~~ue, ''-.It/ ,1I1d C,HI11\ldy descriLw tW\l p,l tit'n t~ WillI appe,H tl) h,H't' dt'velllped pwpt\lsi~ related tl) the ,1dl11ini~tr,ltilln llf ~tt'r\lid tl1l'r,lpv. Tht' pl)~~ibilitv that e'\llgt'I1llUS cllrtic\lslt'wid~ Cl)ldd prt)duce e'\ophthall11l)~ is not ,1 nt'w concept. C1mpbt'll ,1I1d Tl)f1k~ (I) product'd experimental e'\l)phthalnll)s in rats with cortisone. Slansk\' t't a!. (2) l)bserved eXt)phthalml)s in four patients who h,H.i been taking systemic prednisone ft)r st'veral \·ears. Two of the patients had pemphigus \'ulgaris and two had rheunh1toid arthritis. All were euthnoid. In one of their cases, there was reduction of exophthalml1s when the dosage of prednistme was decreased. Siansky et a!. (2) also emphasized the observation that about 6-8'/' of patients with Cushing's disease develop exophthalmos. We ha\'e seen several patients with thywid t'ye disease and severe proptosis who have been placed on chronic steroid therapy and who haw had marked improvement in their pwptosis (as well as the rest of their appearance) after steroids were stopped. One of these patients was actually referred for orbital decompression because of her severe proptosis. Six months after steroids were stopped, the patient had virtually no proptosis. Had her disease spontaneously remitted while she was taking steroids, had the stewids produced rt'mission, or was the proptosis caused (at least in 253 ,(, IYHh R<lV....n Prl'_~~, Nl'w York PMt) by the stewids7 This is the pwblem we face in trying to assess the paper of Katz and Carmody. First, it is well known that some patients with euthywid Graves' disease develop an increase in thl' fat content of the orbits and thus develop proptosis without an increase in the size of the extraocular muscles. This could be the case with the two patients described in this paper. Second, the only way to be certain that exogenous steroids were truly responsible for the patients' proptosis would be to stop them and see if the proptosis regressed. If it did, steroids could be restarted to see if the pwptosis would recur. In summary, then, I agree with Drs. Katz and Carmody (and with others) that exophthalmos may be induced by exogellL1us corticostewids, but I am not Cl)Il\'inced that their paper prtn'es this conclusion. Neil R. Miller, M.D. Johns Hopkins Ht1spital Baltinwre, \larvland REFERENCES I, Campbell [lA, l"nh.' F~t. E'pl'nnll'nt,l! l""f'hth'llnw, III rt1to-; dul' tl) thlPlIflH:11 .lnd ll'rti'llill'. Trd'I';' l)1~/lthd!"lt'l ~{ll (/,10. I"'i:;,;-'ihll'i- 22, , SI,m,h.\' III L ""Ibl'rl C, C,lrl,wr S F"'f'hlh'llm," IIldllll'd l'\' ,ll'Wllh, ..I"h l )1,II/h.illllt'l IC't':',;-;- ;;-"" S I |