Carol Lane

Dysthyroid eye disease is the commonest cause of proptosis in adults and the disease typically presents as Graves' disease in the third and fourth decade, with a four- to seven-fold predominance in females. Bilateral orbital inflammation is often accompanied by eyelid retraction and restriction of ocular movements. Asymmetrical involvement and extensive fibrosis are less frequent presentations and the diagnosis of dysthyroid eye disease should always be suspected in the presence of any inflamed orbit or with proptosis.

Sight is threatened by corneal exposure due to incomplete eyelid closure over a proptotic globe, uncontrolled ocular hypertension or optic nerve compression. One-fifth of patients with untreated compressive optic neuropathy develop irreversible visual impairment (to 6/36 or less).

Treatment of dysthyroid eye disease aims to conserve or restore normal visual function, relieve ocular pain and achieve an acceptable appearance.

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