Graves’ Disease

Synonyms

Dysthyroid ophthalmopathy; Thyroid eye disease; Thyroid-associated orbitopathy

Definition

Graves’ disease is an autoimmune inflammatory disorder that affects orbital and periorbital tissue. It is associated with hyperthyroidism at some point in most patients, although in less than 10 % of cases, patients are hypothyroid or euthyroid.

Clinical Presentation

Graves’ disease is always a bilateral process, although it is often asymmetrical. Many of the clinical signs and symptoms arise from soft tissue enlargement in the orbit including both extraocular muscles and adipose tissue. Patients under 40 years of age typically have a predominance of fat expansion, while patients over 60 years of age often have more extraocular muscle swelling. Although multiple muscles may be involved, the inferior rectus is the most common, followed by the medial rectus.

The most common symptoms include orbital pain or discomfort, diplopia, lacrimation, photophobia, and dry eye symptoms. The clinical...