Graves' Ophthalmopathy

In patients with Graves' ophthalmopathy muscle enlargement is due to the deposition of mucopolysccharides, fibrosis, mononuclear cell infiltration, and edema. The exact etiology of tills change is not known, but is thought to be on an autoimmune basis. Similar orbital muscular histopathology is seen in patients with orbital myositis-pseudotumor. The patient may be clinically euthyroid or hyperthyroid at the time of presentation. Clinical signs can be those of lid retraction, lid lag, horizontal muscular dysfunction, vertical muscular dysfunction, proptosis, lid swelling, and optic neuropathy. A variety of classifications have been made relative to the degree of involvement, the greater the involvement the more severe the signs.