**6.14 Eyes**

Bulging eyes (Graves' ophthalmopathy) Graves' ophthalmopathy also called Graves Orbitopathy, Graves Eye Disease, or Thyroid Eye Disease (TED), is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness (erythema), conjunctivitis, and bulging eyes (exophthalmos) It is a problem that develops in people with an overactive thyroid caused by Graves' Disease which increase rate of peripheral blood mononuclear cell conversion into CD34+ fibrocytes. These cells may contribute to the pathophysiology of ophthalmopathy by accumulating in orbital tissues and producing inflammatory cytokines, including TNF-alpha and IL-6. although most cases of thyroid-associated orbitopathy do not result in visual loss, this condition can cause vision-threatening exposure keratopathy, troublesome diplopia, and compressive optic neuropathy.
