Clinical signs of thyroid eye disease

Thyroid Eye Disease (TED) or Thyroid Ophthalmopathy or Grave's Ophthalmopathy is the single most common cause of bilateral proptosis in adulthood. It is associated with orbital involvement in 25-50% of patients and 5-10% of patients may develop serious complications like compressive optic neuropathy improved motility and inflammation. The characteristic clinical signs may include a combination of eyelid signs, lid lag, globe lag, proptosis, restrictive extraocular myopathy and optic neuropathy. Werner's classification is helpful in summarizing the clinical classification of Grave's Ophthalmopathy. Various diseases such as myasthenia gravis, orbital myositis, CPEO etc mimic thyroid eye disease and its important to know how they can be differentiated. Finally blood investigations and imaging studies are very helpful in endorsing the clinical signs and help one arrive at the diagnosis. Since various medical and surgical management is amenable to us, establishing the correct diagnosis of TED is extremely important. This disease may have sight threatening complications, if not diagnosed on time, therefore, it is important to know the clinical signs of TED. The management is conservative most of the times and a better understanding of the immunological pathogenesis may propel the medical management of the disease in a different direction.