CLINICAL-FEATURES OF GRAVES OPHTHALMOPATHY IN AN INCIDENCE COHORT

PURPOSE: To determine the clinical characteristics of an incidence coh ort of patients with Graves' ophthalmopathy. METHODS: We reviewed the community medical records of 120 patients residing in Olmsted Coun ty, Minnesota, in whom Graves' ophthalmopathy was diagnosed between 1975 and 1990. RESULTS: Among 120 patients with Graves' ophthalmopathy, 108 (90%) patients had Graves' hyperthyroidism, one (1%) had primary hypo thyroidism, four (3%) had Hashimoto's thyroiditis, and seven (6%) were euthyroid. At some point in their clinical course, eyelid retraction was present in 108 patients, whereas the approximate frequency of exop hthalmos was 62% (73 patients); restrictive extraocular myopathy, 43% (51 patients); and optic nerve dysfunction, 6% (seven patients). Only six (5%) patients had eyelid retraction, exophthalmos, optic nerve dys function, extraocular muscle involvement, and hyperthyroidism. At the time of diagnosis of ophthalmopathy, upper eyelid retraction and eyeli d lag were documented in 85 and 52 patients, respectively, and the mos t frequent ocular symptom was pain (36 patients, 30%). Diplopia was no ted at the initial examination by 20 patients, lacrimation was pres en t in 25 patients, 19 patients had photophobia, and nine patients had b lurred vision. Decreased vision from optic neuropathy was present in l ess than 2% of eyes at the time of diagnosis. Thyroid dermopathy and a cropachy accompanied Graves' ophthalmopathy in five patients (4%) and one (1%) patient, respectively. Myasthenia gravis occurred in only one patient. CONCLUSIONS: Eyelid retraction is the most common clinical s ign of Graves' ophthalmopathy. The complete constellation of typical f eatures (hyperthyroidism, eyelid retraction, exophthalmos, restrictive extraocular myopathy, and optic nerve dysfunction) occurs relatively infrequently.