Signs on physical exam include eyelid retraction, lid lag, lagophthalmos, and staring appearance related to increased sympathetic innervation reduced blinking, conjunctival injection and superficial keratopathy related to exposure limitation of extraocular motility as a result of periorbital edema and stimulation of retroocular fibroblasts and decreased visual acuity, decreased color vision, relative afferent pupillary defect, and visual field defect as a result of optic neuropathy in the most advanced cases. The symptoms include red eye, ocular pain or discomfort, foreign body sensation, tearing, binocular diplopia, dyschromatopsia, and decreased visual acuity. Thyroid-associated ophthalmopathy (TAO) is the most common extrathyroidal manifestation of Graves’ disease, which is an autoimmune condition characterized by hyperthyroidism and diffuse goiter as a result of thyroid stimulating immunoglobulin (TSI).Ĭlinical Manifestations: The four critical sequelae of TAO are eyelid disorders, eye surface disorders, ocular motility disorders, and optic neuropathy. Introduction: In adults, the most common cause of both unilateral and bilateral proptosis is thyroid ophthalmopathy related to Graves’ disease, whereas the most common cause of unilateral proptosis in children is orbital cellulitis. Note the inferior scleral show, and conjunctival injection.ĭefinition: Proptosis, or exophthalmos, refers to a protrusion of the eyeball caused by an increase in orbital pressure or contents. Image 2: A patient with thyroid-associated ophthalmopathy. Image 1: A patient with severe thyroid-associated ophthalmopathy which resulted in conjunctival chemosis (conjunctival swelling) and periorbital edema. Author: Blake Fortes, 4 th Year Medical Student, Florida International University Herbert Wertheim College of Medicine
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