Graves‘ or Basedowljev’s disease is of autoaggressive etiology, characterized by the triad of signs: hyperthyroidism with diffuse goiter, ophthalmopathy and dermathopathy. These three events may not appear all together, so the disease should be suspected on even when thyroid tests are normal. Specifically, 10-25% of cases of disthyroid ophthalmopathy have no clinical or biochemical signs of thyroid dysfunction.

Thyroid ophthalmopathy is the most common cause of proptosis. It is mostly mutual, although it may occur earlier on one side than the other.





The most important signs of thyroid ophthalmopathy are exophthalmos, disclosure of the upper cornea when looking down, and eyelid retraction. Eyelid retraction makes exophthalmos even more pronounced. In severe cases, there are symptoms of limited mobility of external ocular muscles, and diplopia. In most severe cases, compression of the optic nerve causes vision impairment. In very severe exophthalmos the eyelids do not cover the surface of the cornea, so because of the exposure keratitis and conjunctivitis occur. Exophthalmos and disturbance of bulbomotoric are a consequence of the inflammatory infiltration of the orbital contents (except the eyeball) and mostly ocular muscles. Wide eyelid opening and rarely blinking are the result of sympathetic stimulation induced by hyperthyroidism.

Signs of thyroid ophthalmopathy named according to the authors:

von Graefe’s sign = when looking down – a retraction of the upper eyelid with the unveiling of the upper part of the cornea

Darlymple’s sign = wide open eyelid opening

Stellwag’s sign = rarely blinking eyelids (stiff, staring gaze)

Joffroy’s sign = when looking up, the forehead doesn’t wrinkle

Möbius sign = disturbances of convergence

Knie’s sign = Unequal pupil dilatation


In mild cases, it is not necessary. In severe cases, steroids are given systemically, and sometimes a surgical decompression of the orbit is required. With exposure of the cornea, a methylcellulose is dropped in the eye or damp chamber is put. Thyroid ophthalmopathy sometimes spontaneously withdraws, but it can also survive after reaching euthyreosis.