Dysthyroid Ophthalmopathy

The most common cause of bilateral proptosis is Graves' disease. Seventy percent of cases are bilateral and symmetrical. In cases of unilateral involvement, other diseases must be considered. Females are more frequently affected than males. The disease is characterised by symmetrical swelling of the extraocular muscles. The inferior and medial rectus muscles are most often involved. The muscle enlargement characteristically involves the body of the muscle, sparing the tendinous attachment to the globe. Histologically, the fibrous tissue of the orbit and the swollen muscles show oedema and chronic inflammation in early stages and fibrosis in end-stage disease. The degenerated muscle fibres become hyalinised.

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