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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). Complete or partial dislocation from the orbit is also possible from trauma or ...
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 ...
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]
Differential diagnosis Graves disease Joffroy's sign is a clinical sign in which there is a lack of wrinkling of the forehead when a patient looks up with the head bent forwards. [ 1 ]
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.
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.
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.
The diagnosis may be suspected based on symptoms and confirmed with blood tests and radioiodine uptake. [1] [4] Typically, blood tests show a raised T 3 and T 4, low TSH, increased radioiodine uptake in all areas of the thyroid, and TSI antibodies. [4] The three treatment options are radioiodine therapy, medications, and thyroid surgery. [1]