Talk about hyperthyroidism proptosis

  The ocular manifestations of hyperthyroidism are divided into two categories: simple proptosis, the cause of which is related to increased sympathetic excitability due to thyrotoxicosis; and infiltrative proptosis, also known as GO, thyroid-associated ophthalmopathy (TAO), and in recent years GD orbital disease, the cause of which is related to the autoimmune inflammatory response of the periorbital tissues.  Simple proptosis includes the following manifestations: 1. mild proptosis: the proptosis does not exceed 18 mm; 2. Stellwag’s sign: reduced transients and jowls; 3. upper lid contracture and widened lid fissures; 4. Von Graefe’s sign: when both eyes look down, white sclera appears because the upper eyelids cannot fall with the eyes; 5. Joffroy’s sign: when the eyes look up, the forehead skin cannot be wrinkled 6. Mobius sign: poor convergence of the eyes when both eyes look at near objects. These signs are associated with increased sympathetic excitability due to thyrotoxicosis.  Patients with infiltrative proptosis (GO) complain of intraocular foreign body sensation, distension, photophobia, tearing, diplopia, strabismus, and decreased visual acuity; examination reveals proptosis (eyeball projection exceeding the upper limit of normal value by 4 mm), eyelid swelling, conjunctival congestion and edema, limited eye movement, and in severe cases, eye fixation, incomplete eyelid closure, corneal ulceration due to corneal exposure, total uveitis, and even blindness. Orbital CT reveals swelling and thickening of the extraocular muscles.