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Eye (2006) 20, 569573
& 2006 Nature Publishing Group All rights reserved 0950-222X/06 $30.00www.nature.com/eyeC-C Tsai1,2,3, H-C Kau2,4, S-C Kao1,2and W-M Hsu1,2Exophthalmos
of patients with
Graves disease in
Chinese of TaiwanCLINICALSTUDYAbstractPurpose To determine the exophthalmosmeasurements in patients with Gravesdisease (GD) and to compare with thoseof normal subjects among the Chinese ofTaiwan.Methods Hertels exophthalmometry wereperformed in 163 consecutive adult GDpatients and 419 normal subjects. The valuesof exophthalmos, asymmetry, and the distancebetween lateral orbital rims (base) wereevaluated.Results There was a significant differencebetween GD and normal adults forexophthalmos and asymmetry, with GDpatients demonstrating a mean exophthalmosof 18.32 mm and asymmetry of 0.93 mm ascompared with 13.91 and 0.55 mm for normalsubjects (Po0.001). The mean value of base forGD adults (106.52 mm) is slightly greater thannormal subjects (105.82 mm). There was nogender difference in exophthalmometric valueor asymmetry in each group. A total of 79(48.5%) GD patients had exophthalmos greaterthan the upper limit of normal Chinese inTaiwan (18.6 mm). Asymmetry over 2 mm wasobserved in 11 (6.7%) patients with GD but innone of the normal subjects.Conclusions GD patients have significantexophthalmos and asymmetry compared tonormal subjects. In comparison with previousstudies, exophthalmos values for Chinese inTaiwan tend to be lower than those ofCaucasians and black-American people, butare close to those of Korean, Japanese, Iranian,Indian, and Asian-American people. Adequateadjustment of normal and abnormal values ofexophthalmos according to individualdifferences is important for the diagnosis oforbital morbidity and management of thyroidassociated orbitopathy.Eye (2006) 20, 569573. doi:10.1038/sj.eye.6701925;published online 20 May 2005Keywords: exophthalmos; Graves disease;Hertels exophthalmometryIntroductionRacial differences regarding eyeball position areimportant to clinical assessment and treatmentof exophthalmos patients who have experiencedtrauma or may have possible inflammatory,infectious, vascular, neoplastic, autoimmune orcongenital diseases. In adults, thyroidassociated orbitopathy (TAO) is the mostcommon cause of unilateral or bilateralexophthalmos. The differences in normal orGraves disease (GD) exophthalmos for bothblack and white populations have been welldescribed,16 but the ethnic difference especiallyin the Chinese has rarely been recognized inEnglish literature. In this study, we compare theexophthalmos of GD adult patients with thoseof normal subjects among the Chinese ofTaiwan, and also review the published papers tocompare such ophthalmic differences betweenvarious racial and ethnic groups.Materials and methodsBetween January 2002 and May 2004, 163consecutive patients (61 male and 102 female)with GD, and 419 randomly selected normal,healthy subjects (188 male and 231 female) seenat the eye clinic of Taipei...