- 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
Graves ophthalmopathy - External and Internal Eye
Alerts and Notices
Synopsis
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:
Codes
ICD10CM:
E05.01 – Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm
SNOMEDCT:
276177000 – Thyroid eye disease
E05.01 – Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm
SNOMEDCT:
276177000 – Thyroid eye disease
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
The differential diagnosis for TAO includes:
Remember also that thickened extraocular muscles can occur with sarcoidosis, metastases, lymphoma, amyloid limited to these muscles and primary amyloidosis, and acromegaly.
- Orbital cellulitis – Onset of proptosis is faster; there is other evidence of infection.
- Carotid cavernous fistula – Often cranial bruit present.
- Orbital inflammatory syndrome (orbital pseudotumor) – Ptosis more often than lid retraction, isolated enlargement of lateral rectus muscle.
- Parinaud syndrome – Globes elevate on doll's head maneuver; no proptosis or injection.
- Sarcoidosis
- Ectropion
Remember also that thickened extraocular muscles can occur with sarcoidosis, metastases, lymphoma, amyloid limited to these muscles and primary amyloidosis, and acromegaly.
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Updated:02/06/2020
Graves ophthalmopathy - External and Internal Eye