ABSTRACT
The exophthalmos and visual damage seen in some patients with Graves’ hyperthyroidism are well-known extrathyroidal manifestations of that disease (1-3). Acropachy and pretibial myxedema, or dermopathy, are also components of what is known as Graves’ disease. Exophthalmos, or proptosis, occurs because of swelling of the orbital contents, in particular the extraocular muscles and the surrounding orbital connective tissue. Graves’ orbital disease, or ophthalmopathy, occurs in 25-50% of patients with Graves’ hyperthyroidism, occasionally in patients with Hashimoto’s thyroiditis, and rarely in those with no evident thyroid disease (4,5). In this chapter we use the term thyroid-associated ophthalmopathy (TAO) to indicate ophthalmopathy associated with Graves’ hyperthyroidism or Hashimoto’s thyroiditis. The eye changes of Graves’ disease can be classified as infiltrative or noninfiltrative (6). Features of infiltrative ophthalmopathy include edema of the lids, periorbital tissues, and conjunctiva; conjunctival injection and eye pain; irritation; and a sensation of grittiness. These features comprise what has been called the congestive ophthalmopathy subtype of TAO (7). The extraocular muscles may be infiltrated, inflamed, and enlarged, affecting the eye’s ability to move and resulting in diplopia and sometimes a complete loss of oculomotor activity. These latter changes comprise the ocular myopathy subtype of TAO. In other patients both types occur in mixed disease.
