Clinical features

• 5-10% cases are unilateral

Presentation may include:

• orbital pain
• lacrimation
• photophobia
• blurred or double vision

Features found on examination may include:

• proptosis - usually bilateral, often asymmetric; less commonly, symmetrical
• lid retraction and lid lag
• periorbital puffiness
• impaired extraocular muscle function
• chemosis - conjunctival oedema - and injection
• exposure keratitis; possibly, corneal ulceration
• ophthalmoplegia - generally superior rectus producing diplopia maximal on upward and outward gaze
• reduced visual acuity
• papilloedema; optic atrophy
• pretibial dermopathy (the least common manifestation of Grave's disease) occurs in patients with severe ophthalmology - generally occurs as a nodular or diffuse thickening of the skin of the anterior lower leg, but it can occur elsewhere.