It is easy to note the particular aspect of some people who draw our attention to the presence of prominent eyeballs, almost out of their sockets. Their gaze is fixed, shiny, lids are removed, and the eyes are irritated. This condition, called exophthalmos or exophthalmia can occur most frequently in association with thyroid disorders.

Located in the neck, the thyroid is composed of two lobes and an isthmus and is responsible for the secretion of thyroid hormone. Basedow disease is associated with two diseases: exophthalmos (which occurs most frequently bilateral although sometimes asymmetric) and hyperthyroidism (increased secretion of thyroid hormones). It occurs mainly in women between 30-40 years.

Hyperthyroidism can result in:

-Excessive sweating, moist palms;
-Increased heart rate;
-Extremities tremor, excessive emotionality and agitation;
-Thinning hair.
Thyroid hyperfunction diagnosis can be made by determination of hormones called T3 and T4 by ultrasound and scintigraphy thyroid antibody determination. If hormones T3 and T4 values are within the range considered normal and clinically suspected hyperthyroidism, may be used and other hormonal determinations. Ophthalmologic manifestations occurring in Basedow disease are caused by infiltration of tissues within the orbit and eyelids with accumulations of organic substances that attract water.

Signs and symptoms of ocular damage

Ocular manifestations are variable; in few cases reach the final stages of illness. The first symptoms are related to inflammation and tissue infiltration; then appear the chronic stage in which the eye was quiet but may persist for a sequel of previous damage.

In the early stages occur only patient’s symptoms:

-Feeling of irritation
– gaze fixed and bright
– eye pain.
Then, there are:
-Eyelid swelling
– redness eyes
– eyelids retraction
– protruding.

When the extra ocular muscles are affected, are involved:

Deviation of the eyes (strabismus) or limitation of eye movement in certain directions – double vision.
In advanced stages, vision is decreased by affecting the cornea or optic nerve (usually at this point exophthalmos is very marked).
Eye disease progression
As noted, it is not always accompanied by hyperthyroidism, even if are simultaneous, its evolution is independent of the thyroid damage and unfortunately, treatment and control of thyroid disease does not always affect exophthalmos. The disease is variable, generally is progressive but is usually restricted spontaneously after a few years (median 3 years). After remission can stay eyelid retraction, exophthalmos, or strabismus in a certain degree.


Eye irritation surface is treated with artificial tears, nocturnal rest, cushion can be raised to reduce swelling of the eyelids; rarely diuretics are recommended for the same purpose; dressing eyes at night is useful if the eyelids are no longer close completely. In cases of progressive exophthalmos which rapidly evolving and is accompanied by ocular complications, is recommended inflammatory treatment that can be associated with orbital irradiation. If the disease progresses despite this treatment and is threatening the integrity of the optic nerve and eyeball, is performed surgery which removes fragments from orbit walls to decompress it.

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