Friday, 6 February 2009

thyroid eye disease

thyroid eye disease is a manifestation of Graves' disease but can occure in patient who may be hyper/hypo or euthyroid.

ask the patient about;

1-smoking (risk factor)

2-blurred vission

3-impaired perception of colour

on examination:


Look at the eye when it is closed/from side,back

-Exophthalmoses:(protrusion of the eye ball)

-Look for cornea, conjunctiva


2- 2nd cranial nerve:

-visual aquity

-visual field

-relative afferent pupilary defect

-colour vision

3- 3rd/ 4th/ 6th cranial nerves:

Examine eye movements looking for

Opthalmoplegia (limitation of eye movement)

4- comment od led lag/retraction (thyrotoxicosis from any cause)

what featurs are specific to Grave's disease?


  1. exophthalmos (protruding eye ball) and ophthamoplagia (limitation of eye movement)occure only in patients with Graves' disease.

    lid retraction and lid lag occure in any form of hyperthyrodism due to sympathatic over-stimulation.

  2. For this lady: Exophtalmos, lid retraction.
    Other eye signs that maybe observed include: diplopia, lid lag, proptosis, complex ophthalmoplegia.

    About the specific signs for hyperthyroidism- pretibial myxedema

  3. 1. EXOPTHALMOS means lid retraction showing the white part of the eye above and below
    2. Proptosis meaning protruding of the eyeball examined from behind by looking downward onto the eye
    3. Pre-tibial myxodema
    4. Graves opthalmopathy
    5. Thyroid acropatchy resembling finger clubbing

  4. ophthalmoplegia is not specific for Grave's it can occure in any lesion causing 3rd 4th or 6th CN palsy in addition to disease of muscles in Caverneous sinus syndrome and Kearn-Syre syndrome...MG ...etc
    also pretibial myxedema dosent imply thyrotxic state...but may be seen even if pt is eu hyper or hypothyroidism albeit specific for Grave's

  5. ophthamoplagia is class 4 in the grave's eye disease clissification.that means it is specific for Grave's disease as far as thyroid eye disease is concerned.the question is can ophthamoplagia ocure in other forms thyroid eye disease apart from Grave's?the answer in my opinion is no.