<prompt> True statement about dysthyroid eye disease graves opthalmopathy isDecreased power of divergenceMost common cause of UL proptosis inExtreme exopthalmos is usually seen in hypothyroidismOn looking upwards lower lid does not follow eye movements  <response>: C. i.e. Extreme exopthalmos is usually seen in hypothyroidism A mild exopthalmos is associated with thyrotoxicosis and an extreme exopthalmos may be associated with any state of thyroid activity, but usually in hypothyroidism often after thyroidectomy.Q Dysthyroid Graves-Opthalmopathy or Endocrine Malignant-Exopthalmos Etiology Clinical Features Treatment Autoimmune in General Thyrotoxicosis Ocular GuanethidineQ may which there is SymptomsQ Dalrympes Sign- decrease lid antibody - Tiredness Retraction of upper eye lid producing Staring retraction caused by mediated attack - Emotional lability Frightened appearanceQ over.action of on orbital - Heat intolerance Mn-D for Dar mullers muscleQ fibroblast - Weight loss Von Graefes Sign- Systemic Steroids primarily, extraocular - Excessive appetite - Palpitation Lid lag i.e on looking downwardsQ towards Ground upperlid follows tardily or not at all Radiotherapy if steroids not muscles being SignsQ Mn-Graefe-Lid lag on looking Ground effective 1000 rad secondarily - Tachycardia persist during Stellwags Sign- from each lateral involvedQ sleepQ Infrequent blinking with deficient closure of po for reducing Pathology - Hot, moist palms lidsQ orbital edema Mononuclear cell - Agitation Mn-S for Still Aificial tears inflammation - Thyroid goiter bruit IVRibius Sign- Lateral with presence of - Myopathy of proximal Decreased power of convergenceQ tarsorrhaphy to mucopolysacchri muscles Mn- M for On looking Medially prevent exposure des Stages of development of Enroths Sign- keratopathy predominantly cardiac arrhythmias Fullness of eylids d1 puffy Edematous Prismatic glasses for hyluronic acid - Tachycardia which persist swelling diplopia together with during sleep Mn- E for Edematous lid Orbital Interstial edema characteristicQ Giffords Sign- decompression inflamatory - Multiple extra systole Difficulty in eversion of upper lid When steroid cells - Paroxysmal atrial Exopthalmos Proptosis have proved tachycardia Weakness of extraocular muscles paicularly ineffective two wall - Paroxysmal atrial elevators inferior obliqueQ causing diplopia orbital floor fibrillation Conjunctival injection over inseion of recti medial wall - Persistent atrial fibrillation Increased intra ocular pressure removed not responding to digoxin Superior limbic keratopathy decompression is done 28 Grade 4 Extraocular muscle involvement Q limitation of movement diplopia Grade 5 Corneal involvement exposure keratitis Grade 6 Loss of Sight dt optic nerve involvement with disc pallor or papilloedema visual field defect v:shapes_x0000_s1026Graves opthalmopathy is most common cause of UL or BL proptosis in adults between age of 25-50 yearsQ Werner Classification reflect severity of opthalmopathy and is well known by acronym of NO SPECS. Grade 0 - No signs or symptoms Grade 1 - Only signs lid retraction with or without lid lag Q mild proptosis Grade 2 - Soft tissue involvement chemosis, grit, lacrimation, photophobia, lid or conjuctival swelling Grade 3 Proptosis Q minimal28 Grade 4 Extraocular muscle involvement Q limitation of movement diplopia Grade 5 Corneal involvement exposure keratitis Grade 6 Loss of Sight dt optic nerve involvement with disc pallor or papilloedema visual field defect 