Purpose: To evaluate the prevalence and severity of ophthalmic manifestations of Graves’ disease in the Mashhad University of Medical Sciences endocrine clinics .

Methods: In a multicenter prospective-descriptive study, patients with Graves' disease that were being followed in Mashhad University of Medical Sciences endocrine clinics were recruited for the study, from December 2002 to September 2005. A comprehensive ophthalmic assessment including visual acuity, external eye examination, ocular motility examination, exophthalmometry, tear status evaluation, intraocular pressure (IOP) measurement, slit lamp examination, and funduscopy were performed. We also evaluated the recent thyroid disease status and the treatment regimen of all patients. The classification of ophthalmopathy was based on the classification by the American Thyroid Association.

Results: Sixty-eight patients (24 men and 44 women) were studied. The mean age of the patients was 37.98±14 (range 15 to 71) years. The mean duration of systemic thyroid disease was 2.46±2.36 years (range 6 months to 11 years). The majority of patients had hyperthyroidism at the time of visit (86.2%) and only 3% of the patients were hypothyroid. The most common complaints of patients were foreign body sensation (54%) and puffy eyelids (48.4%). Mean Snellen visual acuity was 0.9±0.17 . The most prevalent sign was increased IOP in upgaze (88.2%) . Increased IOP in upgaze had a statistically significant association with limitation of extraocular movements (4.57 mm Hg vs. 2.56 mm Hg in the presence and absence of gaze limitation, respectively P=0.03). The most common clinically evident abnormality was lid retraction, which was noticed in 64.2% of patients. Lid retraction was bilateral in 95.3% of the cases. Exophthalmos was present in 53%. Injection over the insertion of horizontal recti was noticed in 48.5% and ocular motility limitation in 19.1%. Tear breakup time was abnormal (less than 10 seconds) in 55.9% of the patients with a mean of 17.76±6.18 mm (range 4-30 mm) the Schirmer’s test was abnormal in 10.3% of patients too. The patients had a mean modified Werner’s NOSPECS classification score of 3 with an SD of 1.46. The score was significantly affected by sex, and was higher in males (3.58 vs. 2.63 in females P<0.01). The score was positively correlated with the age of the patients (r=0.298, P=0.016).

Conclusion: Our study of a relatively large number of patients replicated the known epidemiological facts regarding Graves ’ ophthalmopathy in Mashhad with slight epidemiologic variations.