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Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease ) or unilateral (as is often seen in an orbital tumor).
Two signs are truly diagnostic of Graves' disease (i.e., not seen in other hyperthyroid conditions): exophthalmos and non-pitting edema (pretibial myxedema). Goiter is an enlarged thyroid gland and is of the diffuse type (i.e., spread throughout the gland).
In approximately 20% of ophthalmopathy patients, ophthalmopathy appears before the onset of hyperthyroidism, in about 40% concurrently, and in about 20% in the six months after diagnosis. [22] In the remainder, the eye disease first becomes apparent after treatment of the hyperthyroidism, more often in patients treated with radioiodine. [23]
In mild disease, patients present with eyelid retraction. In fact, upper eyelid retraction is the most common ocular sign of Graves' orbitopathy. This finding is associated with lid lag on infraduction (Von Graefe's sign), eye globe lag on supraduction (Kocher's sign), a widened palpebral fissure during fixation (Dalrymple's sign) and an incapacity of closing the eyelids completely ...
Chronic progressive external ophthalmoplegia (CPEO) is a type of eye disorder characterized by slowly progressive inability to move the eyes and eyebrows. [1] It is often the only feature of mitochondrial disease, in which case the term CPEO may be given as the diagnosis.
Differential diagnosis Graves-Basedow disease Abadie's sign of exophthalmic goiter is a medical sign characterized by spasm of the levator palpebrae superioris muscle with retraction of the upper lid (so that sclera is visible above cornea ) seen in Graves-Basedow disease which, together with exophthalmos causes the bulging eyes appearance.
Stellwag's sign is a sign of infrequent or incomplete blinking associated with exophthalmos or Graves orbitopathy. It is accompanied by Dalrymple's sign, which is a retraction of the upper eyelids resulting in an apparent widening of the palpebral opening. Stellwag's sign is named after Austrian ophthalmologist Karl Stellwag von Carion.
Boston's sign is the spasmodic lowering of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter. [1]Similar to von Graefe's sign, it is observed in people with Graves-Basedow disease, a type of hyperthyroidism.