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Graves ophthalmopathy - External and Internal Eye
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Graves ophthalmopathy - External and Internal Eye

Contributors: Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
Other Resources UpToDate PubMed


Although thyroid eye disease, Graves ophthalmopathy, dysthyroid ophthalmopathy, and Graves disease are all used interchangeably, current preference for the ocular changes that can occur with thyroid disease is to use the term thyroid associated ophthalmopathy (TAO) or orbitopathy. Not only is this more specific, but it covers the fact that TAO can occur despite all testing for thyroid disease being normal. TAO is an autoimmune disorder, and it can involve nearly all the ocular structures. Thus, symptoms are related to which ocular structures are affected. The list of possible presentation symptoms include:
  • Dry eyes
  • Tearing
  • Puffy eyelids
  • Chemosis of the conjunctiva
  • Red, angry-looking eyes (especially overlying the insertions of the rectus muscles)
  • Bulging eyes
  • Diplopia
  • Visual blurring or loss
  • Visual Field loss
  • Dyschromatopsia
  • Photopsia on upgaze
  • Ocular pain and/or pressure
Some 80% of patients with systemic hyperthyroidism develop TAO. TAO affects women 2.5-6 times more frequently than men, just as Graves disease is more prevalent in females. Graves disease is more common in African Americans and Asians compared with whites. Interestingly, when TAO is present in males, it is usually more severe. The usual age range is 30-50 years.


E05.01 – Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm

276177000 – Thyroid eye disease

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Last Updated:12/12/2017
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Graves ophthalmopathy - External and Internal Eye
A medical illustration showing key findings of Graves ophthalmopathy : Eyelid retraction, Proptosis, Dry eyes, TSH decreased
Clinical image of Graves ophthalmopathy - imageId=1858880. Click to open in gallery.
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