In mild disease, patients present with eyelid retraction. In fact, upper eyelid retraction is the most common ocular sign of Graves' orbitopathy. This finding is associated with lid lag on infraduction (Von Graefe's sign), eye globe lag on supraduction (Kocher's sign), a widened palpebral fissure during fixation (Dalrymple's sign) and an incapacity of closing the eyelids completely (lagophthalmos, Stellwag's sign). Due to the proptosis, eyelid retraction and lagophthalmos, the cornea is more prone to dryness and may present with chemosis, punctate epithelial erosions and superior limbic keratoconjunctivitis. The patients also have a dysfunction of the lacrimal gland with a decrease of the quantity and composition of tears produced. Non-specific symptoms with these pathologies include irritation, grittiness, photophobia, tearing, and blurred vision. Pain is not typical, but patients often complain of pressure in the orbit. Periorbital swelling due to inflammation can also be observed. ;Eye signs Sign Description Named for Abadie's sign Elevator muscle of upper eyelid is spastic. Jean Marie Charles Abadie (1842–1932) Ballet's sign Paralysis of one or more EOM Louis Gilbert Simeon Ballet (1853–1916) Becker's sign Abnormal intense pulsation of retina's arteries Otto Heinrich Enoch Becker (1828–1890) Boston's sign Jerky movements of upper lid on lower gaze Leonard Napoleon Boston (1871–1931) Cowen's sign Extensive hippus of consensual pupillary reflex Jack Posner Cowen, American ophthalmologist (1906–1989) Dalrymple's sign Upper eyelid retraction John Dalrymple (1803–1852) Enroth's sign Edema esp. of the upper eyelid Emil Emanuel Enroth, Finnish ophthalmologist (1879–1953) Gifford's sign Difficulty in eversion of upper lid. Harold Gifford (1858–1929) Goldzieher's sign Deep injection of conjunctiva, especially temporal Wilhelm Goldzieher, Hungarian ophthalmologist (1849–1916) Griffith's sign Lower lid lag on upward gaze Alexander James Hill Griffith, English ophthalmologist (1858–1937) Hertoghe's sign Loss of eyebrows laterally Eugene Louis Chretien Hertoghe, Dutch thyroid pathologist (1860–1928) Jellinek's sign Superior eyelid folds is hyperpigmented Edward Jellinek, English ophthalmologist and pathologist (1890–1963) Joffroy's sign Absent creases in the fore head on upward gaze. Alexis Joffroy (1844–1908) Jendrassik's sign Abduction and rotation of eyeball is limited also Ernő Jendrassik (1858–1921) Knies's sign Uneven pupillary dilatation in dim light Max Knies, German ophthalmologist (1851–1917) Kocher's sign Spasmatic retraction of upper lid on fixation Emil Theodor Kocher (1841–1917) Loewi's sign Quick Mydriasis after instillation of 1:1000 adrenaline Otto Loewi (1873–1961) Mann's sign Eyes seem to be situated at different levels because of tanned skin. John Dixon Mann, English pathologist and forensic scientist (1840–1912) Mean sign Increased scleral show on upgaze (globe lag) Named after the expression of being "mean" when viewed from afar, due to the scleral show Möbius's sign Lack of convergence Paul Julius Möbius (1853–1907) Payne–Trousseau's sign Dislocation of globe John Howard Payne, American surgeon (1916–1983), Armand Trousseau (1801–1867) Pochin's sign Reduced amplitude of blinking Sir Edward Eric Pochin (1909–1990) Riesman's sign Bruit over the eyelid David Riesman, American physician (1867–1940) Movement's cap phenomenon Eyeball movements are performed difficultly, abruptly and incompletely Rosenbach's sign Eyelids are animated by thin tremors when closed Ottomar Ernst Felix Rosenbach (1851–1907) Snellen–Riesman's sign When placing the stethoscope's capsule over closed eyelids a systolic murmur could be heard Herman Snellen (1834–1908), David Riesman, American physician (1867–1940) Stellwag's sign Incomplete and infrequent blinking Karl Stellwag (1823–1904) Suker's sign Inability to maintain fixation on extreme lateral gaze George Francis "Franklin" Suker, American ophthalmologist (1869–1933) Topolanski's sign Around insertion areas of the four rectus muscles of the eyeball a vascular band network is noticed and this network joints the four insertion points. Alfred Topolanski, Austrian ophthalmologist (1861–1960) von Graefe's sign Upper lid lag on down gaze Friedrich Wilhelm Ernst Albrecht von Gräfe (1828–1870) Wilder's sign Jerking of the eye on movement from abduction to adduction Helenor Campbell Wilder (née Foerster), American ophthalmologist (1895–1998) In moderate active disease, the signs and symptoms are persistent and increasing and include myopathy. The inflammation and edema of the extraocular muscles lead to gaze abnormalities. The inferior rectus muscle is the most commonly affected muscle and patient may experience vertical diplopia on upgaze and limitation of elevation of the eyes due to fibrosis of the muscle. This may also increase the intraocular pressure of the eyes. The double vision is initially intermittent but can gradually become chronic. The medial rectus is the second-most-commonly-affected muscle, but multiple muscles may be affected, in an asymmetric fashion. In more severe and active disease, mass effects and cicatricial changes occur within the orbit. This is manifested by a progressive exophthalmos, a restrictive myopathy that restricts eye movements and an optic neuropathy. With enlargement of the extraocular muscle at the orbital apex, the optic nerve is at risk of compression. The orbital fat or the stretching of the nerve due to increased orbital volume may also lead to optic nerve damage. The patient experiences a loss of visual acuity, visual field defect, afferent pupillary defect, and loss of color vision. This is an emergency and requires immediate surgery to prevent permanent blindness.
complications of Graves' disease
complications of Hashimoto's thyroiditis
complications of Acromegaly
medical cause of Hyperthyroidism
medical cause of Hypothyroidism
symptom of Graves' disease
complications of Neuroleptic malignant syndrome
complications of Kallmann syndrome