The Severe Eye Changes of Graves' Disease

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,