University of Iowa Health Care

Ophthalmology and Visual Sciences

Asymmetrical bilateral exophthalmus

Contributor: William Charles Caccamise, Sr, MD,, Retired Clinical Professor of Ophthalmology, University of Rochester School of Medicine and Dentistry

Expanded text by Brendan K. Penaluna, May 5, 2017

*Dr. Caccamise has very generously shared his images of patients taken while operating during the "eye season" in rural India as well as those from his private practice during the 1960's and 1970's. While the quality of his images are not up to today's higher web standards, many of his images are significant for their historical perspective and for techniques and conditions seen in settings in undeveloped areas.

Graves' Disease is the most common cause of exophthalmos in adults and is often asymmetrical. The inferior rectus and medial rectus muscles are more commonly inflamed in patients with Graves' exophthalmos. The swelling of inflamed muscles leads to proptosis, and additionally may cause strabismus. Additionally, dry eye and the risk of optic nerve compression must be addressed.

asymmetrical bilateral exophthalmus

In adults, bilateral exophthalmus is most often related to ophthalmic Graves' disease.

Bilateral exophthalmus with Graves' Disease (hyperthyroidism)

Bilateral exophthalmus with Graves' Disease ( hyperthyroidism )'

Bilateral exophthalmus with Graves'Disease. Marked lid retraction O.U. - Dalrymple Sign.

Exophthalmos: endocrine type

exophthalmos: endocrine type

Congestion of the angular and temporal bulbar conjunctival blood vessels is a frequent finding in enocrine exophthalmos. It is readily evident in this photo of a patient with a thyroid gland disorder.


Horton JC. Disorders of the Eye. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e New York, NY: McGraw-Hill; 2014. Accessed April 13, 2017.

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Ophthalmic Atlas Images by, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

last updated: 5/5/2017; originally posted in 2005
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