Progress in endocrine exophthalmos.

Abstract

Exophthalmos or proptosis refers to forward displacement of the eyeball and must be distinguished from retraction of the eyelids which causes an illusion of exophthalmos. Lid retraction usually results from activation of the autonomie nervous system. Exophthalmos is a more serious disorder caused by inflammatory and infiltrative changes in the retro-orbital tissues, and is essentially a feature of Graves's disease, though it has been described in chronic thyroiditis1 and may occur in Cushing's syndrome.2 Exophthalmos commonly starts shortly after the development of thyrotoxicosis but may arise months or even years after hyperthyroidism has been successfully treated.3 Only 2-3% of patients with Graves's disease develop severe exophthal mos.4 The degree of exophthalmos is not correlated with the severity of hyperthyroidism, even when their onset is simul taneous. Some of the worst examples of endocrine exophthalmos occur in the euthyroid state and may appear in patients who have never had thyrotoxicosis?a disorder named ophthalmic Graves's disease.