Part of “CHAPTER 43 – ENDOCRINE OPHTHALMOPATHY“

When exophthalmos occurs bilaterally and is accompanied by retraction of the upper lid, with lid lag and limitation of upward gaze, little difficulty is encountered in establishing the diagnosis of Graves ophthalmopathy, even if thyrotoxicosis is absent.6,11,12,50 If proptosis is unilateral, this entity is still the most common cause, but other conditions must be ruled out. A logical, sequential evaluation of the orbit should include studies to separate orbital from periorbital and intracranial lesions and should proceed in a rational fashion without risk to the patient.51 A team effort is necessary that may include the ophthalmologist, endocrinologist, otolaryngologist, nuclear medicine specialist, and neuroradiologist. Table 43-2 shows a useful scheme for the diagnostic evaluation of unilateral exophthalmos. The evaluation of thyroid function is discussed in Chapter 33,Chapter 34,Chapter 35 and Chapter 36.