ABSTRACT
Thyroid eye disease is one of the most common orbital disorders in adults, affecting women four times as often as men. Clinical manifestations include proptosis, restrictive myopathy, compressive optic neuropathy, and eyelid retraction. Patients with lid retraction may appear to have proptosis, or eyelid retraction can make proptosis more disfiguring. Likewise, patients with restriction of upgaze related to severe inferior rectus involvement and hypotropia may have the appearance of lid retraction or have true lid retraction on attempted upgaze. Careful observation and assessment are necessary to differentiate these three findings. Extreme degrees of eyelid retraction can cause exposure keratopathy and reduced visual acuity. This occurs through desiccation and abnormal tear distribution over the cornea, causing an optically irregular corneal surface. The extent and course of eyelid retraction should be included in the evaluation of patients with thyroid eye disease.
