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Exophthalmos is the ocular abnormality most often described in Graves' disease. Repeated emphasis on this aspect of the disease has diverted attention from other ocular disturbances. In fact, most synonyms emphasize this focus—Graves' disease with exophthalmos, exophthalmic goiter, malignant exophthalmos, endocrine exophthalmos, exophthalmic ophthalmoplegia, and exophthalmic ophthalmopathy. Inspection of the eyes in patients with thyroid disease, however, enables us to see a great variety of lesions causing many symptoms. Indeed, exophthalmos may not exist at all in an eye with grossly disturbed function. We have studied the elements of the eye disease associated with thyrotoxicosis and have described them under the term endocrine eye lesion. Hitherto the etiology, pathogenesis, and response to treatment have been studied in highly selected patients with severe eye lesions. In a comprehensive review of endocrine exophthalmos Wybar makes the point that "there is still no true understanding of the basic nature of the exophthalmic
HAMILTON HE, SCHULTZ RO, DE GOWIN EL. The Endocrine Eye Lesion in Hyperthyroidism: Its Incidence and Course in 165 Patients Treated for Thyrotoxicosis with Iodine131. AMA Arch Intern Med. 1960;105(5):675–685. doi:10.1001/archinte.1960.00270170013003
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