Prevalence of asymmetric exophthalmols in graves orbitopathy

Purpose: To report the prevalence and the degree of significant asymmetric orbital involvement secondary to thyroid-related (Graves) orbitopathy in a large patient population. Methods: The prevalence of exophthalmometric differences of greater than or equal to2 mm was determined in 391 consecutive patients diagnosed with Graves orbitopathy from the Jules Stein Eye Institute Division of Ophthalmic Plastic and Reconstructive Surgery patient registry. Results: Thirty-six of 391 patients (9%) in this cohort had asymmetric proptosis with a difference of greater than or equal to2 mm, based on single-observer Hertel measurements before orbital decompression Surgery. This finding was similar among men (11/95, 12%) and women (25/296, 8%) but was not statistically significant (P=0.358: 95% CI, 0.6% to 7.8%). Also. we found no racial variations in the incidence of unilateral disease. Conclusions: Clinically, unilateral or asymmetric Graves orbitopathy is common and can lead to misdiagnosis or to unnecessary testing Thyroid-related orbitopathy must be considered in the differential diagnosis for any case of asymmetric exophthalmos.