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The Severe Eye Changes of Graves' Disease

Sidney C. Werner, M.D.
JAMA. 1961;177(8):551-555. doi:10.1001/jama.1961.73040340001004.
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GRAVES described the association of eye changes and hyperthyroidism in 1835.1 Despite the tremendous body of clinical and investigative data produced since then, the etiologies of both derangements remain undefined. Perhaps because of the lack of a known etiology, a multiplicity of unwieldy terms has arisen to describe the eye changes of Graves' disease; and clinical classification has currently become so confused as to make it difficult to evaluate published data. Only recently, an effort to reach agreement upon a satisfactory terminology failed.2

Classification and Terminology  Most clinics accept the view that 2 distinct categories of eye changes can be defined by clinical criteria, although mixed pictures are common.3 In one group, the ocular manifestations consist essentially of stare, proptosis, widened fissures, and lidlag. These constitute little more than a cosmetic blemish, even though proptosis may exceed 30 mm. by Hertel exophthalmometer measurement. In the other group,


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