title: Prevalence of asymmetric exophthalmos in Graves orbitopathy.
abstract: OBJECTIVE
  To report the prevalence and the degree of significant asymmetric orbital involvement secondary to thyroid-related (Graves) orbitopathy in a large patient population.
  
  
  METHODS
  The prevalence of exophthalmometric differences of > or =2 mm was determined in 391 consecutive patients diagnosed with Graves orbitopathy from the Jules Stein Eye Institute Division of Ophthalmic Plastic and Reconstructive Surgery patient registry.
  
  
  RESULTS
  Thirty-six of 391 patients (9%) in this cohort had asymmetric proptosis with a difference of > or =2 mm, based on single-observer Hertel measurements before orbital decompression surgery. This finding was similar among men (11/95, 12%) and women (25/296, 8%) but was not statistically significant (P= 0.358; 95% CI, 0.6% to 7.8%). Also, we found no racial variations in the incidence of unilateral disease.
  
  
  CONCLUSIONS
  Clinically, unilateral or asymmetric Graves orbitopathy is common and can lead to misdiagnosis or to unnecessary testing. Thyroid-related orbitopathy must be considered in the differential diagnosis for any case of asymmetric exophthalmos.
authors.affiliation: Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, Los Angeles, California, USA.
authors.forename: A Ebbie
authors.initials: AE
authors.lastname: Soroudi
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
authors.forename: John D
authors.initials: JD
authors.lastname: McCann
mesh_terms: D015331:Cohort Studies; D005146:Facial Asymmetry / Q000209:etiology*; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D015995:Prevalence; D012720:Severity of Illness Index