Atypical Manifestations

The clinical features of Graves’ orbitopathy (GO) with eyelid retraction (Dalrymple’s sign), lid-lag (von Graefe’s sign), lagophthalmos, exophthalmos, motility disorders and dysthyroid optic neuropathy (DON) are all well known. The underlying disease is autoimmune thyroid disease and it is often associated with pretibial myxedema and acropachy. The combination of bilateral exophthalmos, lid retraction, stare and enlarged thyroid are virtually pathognomonic for GO. Some ocular signs are relatively specific and these include proptosis and lid-lag or stare, proptosis plus restrictive extraocular myopathy, or the presence of isolated enlarged vessels over the insertions of the medial or lateral rectus muscles. Conjunctival or periorbital edema is also quite common in GO. These typical manifestations of GO have already been described in previous chapters. This chapter reviews the most common atypical manifestations of GO: unilateral or asymmetric exophthalmos, euthyroid GO and globe subluxation as an extreme variant of exophthalmos.