Dear Dr. Donohue — six years ago, my sister, 67 years old, wasdiagnosed with Graves’ disease, and it has affected her eyes. Hasthere been any advancement in research with it? Where is the bestmedical facility for it? — L.B.

Answer — Chalk up another illness to an immune system that turnsagainst its own body. in this case, it’s the thyroid gland and theeyes. Graves’ disease is an enlarged thyroid gland (a goiter)that’s putting out too much thyroid hormone. The stimulation thatcauses the overproduction comes from antibodies made by the immunesystem. Not only do they lead to excess thyroid hormone, they alsolead to deposition in the orbit (the bone socket for the eyes) ofmaterial that pushes the eye outward and infiltrates the eyemuscles. that, in turn, often produces double vision. The namegiven to eye involvement is Graves’ ophthalmopathy ororbitopathy.

Your sister has to protect her eyes by using eyedrops or eyelubricants. When outside, she should wear large sunglasses withside extensions that keep wind out of the eyes.

In the early stages, if eyesight is threatened from the pressureof the infiltrating material on the optic nerve, large doses ofcortisone are given to shrink the infiltration. often, time permitsthe swelling in the orbit to regress.

Six years from the start of her illness, your sister’s eyes arestill a problem. she should be under the care of an ophthalmologistand an endocrinologist (a thyroid specialist). A number of surgicalprocedures can be done to enlarge the bony socket. if she suffersfrom double vision, eye-muscle surgery can correct that, or she canwear glasses with prisms that compensate for eye misalignment.

Dear Dr. Donohue — Will you please explain a rectocele? Issurgery advised? I am 82 years old and concerned about surgery. —C.D.

Answer — A rectocele (RECK-toe-seal) is a downward bulging ofthe rectum into the vagina. A similar bulge of the urinary bladderis a cystocele, and of the uterus, a uterine prolapse. all threeare referred to as pelvic organ prolapse — “prolapse” meaningfalling downward.” The ligaments and muscles supporting thesestructures give way with aging and childbearing.

Surgery for a rectocele is advised if it causes symptoms likestraining to evacuate, or is painful or causes loss of bowelcontrol.

If you don’t want surgery, then try a pessary, a device thatcomes in many shapes and that’s inserted into the vagina to prop upthe fallen organ. your doctor can suggest one best suited to yourproblem.

Write Dr. Donohue at P.O. Box 536475, Orlando, Fla.32853-6475.