title: Double vision is a major manifestation in moderate to severe graves' orbitopathy, but it correlates negatively with inflammatory signs and proptosis.
abstract: BACKGROUND
  Double vision (diplopia) is a major determinant of work disability in patients with Graves' orbitopathy (GO), but is not part of the classification NOSPECS classification of GO.
  
  
  OBJECTIVE
  The objectives of the study were to quantitate diplopia in patients with moderate to severe GO and to study associations with other disease and patient variables.
  
  
  METHODS
  This was a single-center prospective study of consecutive patients at the time of referral.
  
  
  METHODS
  The study was conducted at the University Hospital Thyroid-Eye Clinic.
  
  
  METHODS
  Patients included 216 patients diagnosed with moderate to severe and active GO.
  
  
  METHODS
  Binocular diplopia in field of gaze and monocular fields of motility were prospectively recorded on diagrams and measured by planimetry. Fields of diplopia were correlated to other disease and patient variables.
  
  
  RESULTS
  Six patients had only one functional eye and were excluded. Among the remaining 210 patients, diplopia was present in 75.2%. In patients with diplopia, this ranged from 5% to 100% (observed in 11.4% of patients) of binocular field of gaze. The field of diplopia correlated positively with eye motility restriction and with asymmetrical affection of orbits but negatively with signs of inflammation and proptosis that often are the main outcome measures in clinical studies of GO therapy.
  
  
  CONCLUSIONS
  Diplopia is very common in moderate to severe GO and a major cause for active therapy. In moderate to severe GO, the field of diplopia correlates negatively with some other indicators of disease activity, which may be explained by the physiological properties of binocular fusion.
authors.affiliation: Departments of Endocrinology (P.L., I.B.P., A.C.), Ophthalmology (D.C.B.) and Geriatric Medicine (S.A.), Aalborg University Hospital, and Institute of Clinical Medicine (P.L., I.B.P., S.A.), Aalborg University, DK-9000 Aalborg Denmark; and Diagnostic Centre (A.C.), Silkeborg Hospital, DK-8600 Silkeborg, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Laurberg
authors.forename: Dalia C
authors.initials: DC
authors.lastname: Berman
authors.forename: Inge Bülow
authors.initials: IB
authors.lastname: Pedersen
authors.forename: Stig
authors.initials: S
authors.lastname: Andersen
authors.forename: Allan
authors.initials: A
authors.lastname: Carlé
mesh_terms: D000328:Adult; D004172:Diplopia / Q000209:etiology*; D005094:Exophthalmos / Q000209:etiology*; D005260:Female; D049970:Graves Ophthalmopathy / Q000150:complications*; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies