Abstract
Purpose
To determine the exophthalmos measurements in patients with Graves' disease (GD) and to compare with those of normal subjects among the Chinese of Taiwan.
Methods
Hertel's exophthalmometry were performed in 163 consecutive adult GD patients and 419 normal subjects. The values of exophthalmos, asymmetry, and the distance between lateral orbital rims (base) were evaluated.
Results
There was a significant difference between GD and normal adults for exophthalmos and asymmetry, with GD patients demonstrating a mean exophthalmos of 18.32 mm and asymmetry of 0.93 mm as compared with 13.91 and 0.55 mm for normal subjects (P<0.001). The mean value of base for GD adults (106.52 mm) is slightly greater than normal subjects (105.82 mm). There was no gender difference in exophthalmometric value or asymmetry in each group. A total of 79 (48.5%) GD patients had exophthalmos greater than the upper limit of normal Chinese in Taiwan (18.6 mm). Asymmetry over 2 mm was observed in 11 (6.7%) patients with GD but in none of the normal subjects.
Conclusions
GD patients have significant exophthalmos and asymmetry compared to normal subjects. In comparison with previous studies, exophthalmos values for Chinese in Taiwan tend to be lower than those of Caucasians and black-American people, but are close to those of Korean, Japanese, Iranian, Indian, and Asian-American people. Adequate adjustment of normal and abnormal values of exophthalmos according to individual differences is important for the diagnosis of orbital morbidity and management of thyroid associated orbitopathy.
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References
Knudtzon K . On exophthalmometry: the result of 724 measurements with Hertel's exophthalmometer on normal adult individuals. Acta Psychiatr Neurol 1949; 24: 523–537.
Fledelius HC, Stubgaard M . Changes in eye position during growth and adult life. Acta Ophthalmol 1986; 64: 481–486.
De Juan E, Hurley DP, Sapira JD . Racial differences in normal values of proptosis. Arch Intern Med 1980; 140: 1230–1231.
Migliori ME, Gladstone GJ . Determination of the normal range of exophthalmometric values for black and white adults. Am J Ophthalmol 1984; 98: 438–442.
Dunsky IL . Normative data for Hertel's exophthalmometry in a normal adult black population. Optom Vis Sci 1992; 69: 562–564.
Barretto RL, Mathog RH . Orbital measurement in black and white populations. Laryngoscope 1999; 109: 1051–1054.
Sleep TJ, Manners RM . Interinstrument variability in Hertel-type exophthalmometers. Ophthal Plast Reconstr Surg 2002; 18: 254–257.
O'Donnell NP, Virdi M, Kemp EG . Hertel exophthalmometry: the most appropriate measuring technique. Br J Ophthalmol 1999; 83: 1097.
Musch DC, Frueh BR, Landis JR . The reliability of Hertel exophthalmometry. Ophthalmology 1985; 92: 1177–1180.
Grove AS . Evaluation of exophthalmos. N Engl J Med 1975; 292: 1005–1013.
Smolders MH, Graniewski-Wijnands HS, Meinders AE, Fogteloo AJ, Pijl H, de Keizer RJ . Exophthalmos in obesity. Ophthalmic Res 2004; 36: 78–81.
Wiersinga WM, Smit T, van der Gaag R, Mourits M, Koornneef L . Clinical presentation of Graves' ophthalmopathy. Ophthalmic Res 1989; 21: 73–82.
Kahaly GJ, Bockmann H, Beyer J, Bischoff S . Longterm observation of endocrine ophthalmopathy and retrospective appraisal of therapeutic measures. J Endocrinol Invest 1990; 13: 287–292.
Bahn RS, Heufelder AE . Mechanisms of disease: pathogenesis of Graves' ophthalmopathy. N Engl J Med 1993; 329: 1468–1475.
Prabhakar BS, Bahn RS, Smith TJ . Current perspective on the pathogenesis of Graves' disease and ophthalmopathy. Endocr Rev 2003; 24: 802–835.
Bartalena L, Pinchera A, Marcocci C . Management of Graves' ophthalmopathy: reality and perspectives. Endocr Rev 2000; 21: 168–199.
Bolanos Gil de Montes F, Perez Resinas FM, Rodriguez Garcia M, Gonzalez Ortiz M . Exophthalmometry in Mexican adults. Rev Invest Clin 1999; 51: 341–343.
Sodhi PK, Gupta VP, Pandey RM . Exophthalmometric values in a normal Indian population. Orbit 2001; 20: 1–9.
Kim IT, Choi JB . Normal range of exophthalmos values on orbit computerized tomography in Koreans. Ophthalmologica 2001; 215: 156–162.
Amino N, Yuasa T, Yabu Y, Miyai K, Kumahara Y . Exophthalmos in autoimmune thyroid disease. J Clin Endocrinol Metab 1980; 51: 1232–1234.
Kashkouli MB, Beigi B, Noorani MM, Nojoomi M . Hertel exophthalmometry: Reliability and interobserver variation. Orbit 2003; 22: 239–245.
Bogren HG, Schermer MJ, Franti C, Elfstrom G, Tengroth B . Radiographic exophthalmometry. Trans Am Acad Ophthalmol Otolaryngol 1976; 81: 298–304.
Frueh BR, Musch DC, Garber FW . Exophthalmometer readings in patients with Graves' eye disease. Ophthalmic Surg 1986; 17: 37–40.
Soroudi AE, Goldberg RA, McCann JD . Prevalence of asymmetric exophthalmos in Graves orbitopathy. Ophthal Plast Reconstr Surg 2004; 20: 224–225.
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Tsai, CC., Kau, HC., Kao, SC. et al. Exophthalmos of patients with Graves' disease in Chinese of Taiwan. Eye 20, 569–573 (2006). https://doi.org/10.1038/sj.eye.6701925
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DOI: https://doi.org/10.1038/sj.eye.6701925
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