Ophthalmologists who have frequent contact with persons afflicted with exophthalmic goiter (Graves' disease) are aware that many of these patients complain of some blurring of vision. In the majority of these situations the disturbance of vision is caused by a change in the refraction of the eye secondary to the factor of increased pressure in the orbits. Less frequently the blurring of vision is due to some change in the cornea secondary to its exposure or to glaucoma which develops in cases of exophthalmos accompanied by a marked increase in orbital pressure. In an occasional case papilledema is noted on ophthalmoscopic examination, and any defect of vision that subsequently develops is attributed to this disturbance at the optic papilla.
It is not well known that a disturbance of vision among these persons with endocrine exophthalmos may also develop as a result of an intrinsic disorder within the optic nerve which
HENDERSON JW. Optic Neuropathy of Exophthalmic Goiter (Graves' Disease). AMA Arch Ophthalmol. 1958;59(4):471-480. doi:10.1001/archopht.1958.00940050027001