Unilateral proptosis: the role of medical history

The most common cause of bilateral and unilateral exophthalmus among adults is Graves’ disease. Unilateral exophthalmus, although frequently seen in connection with thyroid diseases, has a much larger differential diagnosis than bilateral exophthalmus. With unilateral presentation one should think of orbital pseudotumour, orbital cellulitis, cavernous sinus thrombosis, or intraorbital neoplasms.1 Graves’ ophthalmopathy (GO) usually is associated with Graves’ hyperthyroidism (GH) although the temporal relation to thyroid disease is not consistent. It has been estimated that 77% of GO patients are hyperthyroid, 21% euthyroid, and 2% hypothyroid.2 The mean absolute interval between GH and GO is 3.3 years in men and 3.6 years in women. Two thirds of patients present with orbital symptoms within 18 months of diagnosis of thyroid disease.3 The following cases of Graves’ ophthalmopathy are described because of their unusual presentation: a long interval between thyroid disease and the development of predominantly unilateral Graves’ ophthalmopathy. Both cases were seen at the department of ophthalmology of the University Hospital Groningen, Netherlands. A female patient born in 1922 became hyperthyroid with minimal eye signs with possibly some lid retraction in 1948. She was treated by thyroidectomy and became …