Background: Orbital signs and symptoms occur in approximately one half
of children with Graves disease, but the symptoms are usually minor a
nd limited to the eyelids. Prominent proptosis is uncommon in children
with this disorder. Methods: Review of eight children with prominent
proptosis associated with thyroid eye disease. Four patients were trea
ted at the Children's Hospital of Philadelphia, the other four at the
Columbia Presbyterian Medical Center. Results: At initial presentation
, children ranged in age from 3 to 16 years, There were five girls and
three boys. Seven of eight children had hyperthyroidism at ophthalmic
presentation. Four patients had restrictive myopathy, and all of the
seven patients who underwent neuroimaging had extraocular muscle enlar
gement. Five patients were treated with lubrication, Two underwent orb
ital fat decompression. One patient had thyroid eye disease and myasth
enia gravis. Conclusions: Proptosis in childhood thyroid eye disease u
sually is associated with a hyperthyroid state. The proptosis may be d
ramatic, but corneal exposure and restrictive myopathy are seen in onl
y some of the patients. Neuroimaging shows enlarged extraocular muscle
s. Most children with this complication can be treated conservatively
with topical lubrication, but orbital fat decompression may be conside
red in patients with more advanced conditions.