Open Access Highly Accessed Research article

Unilateral proptosis in thyroid eye disease with subsequent contralateral involvement: retrospective follow-up study

Diego Strianese1*, Raffaele Piscopo1, Andrea Elefante2, Manuela Napoli2, Chiara Comune1, Immacolata Baronissi1, Raffaele Liuzzi3, Mariantonia Ferrara1, Alessia D’alessandro1, Pasquale Ruggiero1, Pasquale Napolitano1, Piergiacomo Grassi1, Adriana Iuliano1, Carmela Russo2, Arturo Brunetti2 and Giulio Bonavolontà1

Author Affiliations

1 Departement of Visual Science, University of Naples “Federico II”, Naples, Italy

2 Department of Diagnostic Imaging, University of Naples “Federico II”, Naples, Italy

3 Institute of Biostructure and Bioimaging, National Research Council of Italy (CNR), Naples, Italy

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BMC Ophthalmology 2013, 13:21  doi:10.1186/1471-2415-13-21

Published: 30 May 2013



The purpose of this retrospective follow-up study is to evaluate the prevalence of patients with thyroid eye disease presenting with apparent unilateral proptosis and determine the occurrence of exophthalmos in contralateral non-proptotic eye over the time. Associated features with this event were evaluated.


A cohort of 655 consecutive patients affected by thyroid eye disease with a minimum follow-up of 10 years was reviewed. Exophthalmos was assessed by using both Hertel exophthalmometer and computed tomography (CT). The influence of age, gender, hormonal status and of different therapies such as corticosteroids, radiotherapy and surgical decompression on this disease progression was evaluated.


A total of 89 patients (13.5%) (95% confidence interval [CI] 15%-10%) had clinical evidence of unilateral exophthalmos at the first visit. Among these, 13 patients (14%) (95% CI 22%-7%) developed subsequent contralateral exophthalmos. The increase of protrusion ranged from 2 to 7 mm (mean of 4.2). The time of onset varied from 6 months to 7 years (mean time: 29 months). Smoking status, young age and surgical decompression are significantly associated with development of contralateral proptosis (p< .05).


Asymmetric thyroid eye disease with the appearance of unilateral exophthalmos at the initial examination is a fairly frequent event, while subsequent contralateral proptosis occurs less commonly. However, physicians should be aware that young patients, particularly if smokers, undergoing orbital decompression in one eye may need further surgery on contralateral side over time.

Thyroid eye disease; Unilateral proptosis; Exophthalmos