Table 3.

Formal Ophthalmic Examination for Thyroid Eye Disease Based on Vision, Inflammation, Strabismus, Appearance

	Clinical ophthalmic examination	Ancillary eye tests	TED-associated mechanisms	Non-TED-associated causes
Vision Central vision Color vision Peripheral vision	Snellen chart Color plates Pupil testing Fundus examination	Pattern visual evoked response Optical coherence tomography (analyzes optic nerve for nerve fiber loss) Visual field Corneal topography	DON Corneal exposure Dry eye Choroidal folds	Cataract Macular disease Glaucoma Diabetic retinopathy
Inflammation (soft tissue changes) Redness and swelling of eyelids and conjunctiva	Slit-lamp biomicroscope	Clinical photographs EUGOGO	Inflammation Venous congestion Superior limbic keratoconjunctivitis (Fig. 2g)	Allergic infective conjunctivitis Iritis or scleritis Dural cavernous fistula Eyelid margin disease Eyelid infection or neoplasia Orbit neoplasia Orbit inflammation
Strabismus (ocular motility changes) Diplopia Ductions Strabismus	Corneal light reflex test (Supplementary Fig. S1a, b) Cover testing	Orthoptics examination: Perimetric ductions Field of binocular single vision (area of binocular gaze with single image) Fresnel prism Prism measurements	Extraocular muscle restriction	Myasthenia gravis Dural cavernous fistula Orbital myositis Orbital lymphoma Orbital metastasis IgG4 disease Cranial nerve III, IV, VI palsy
Appearance (structural changes) Lid retraction	Ruler measure Marginal reflex distance (the distance between the upper lid margin and the corneal reflex when the eye is in the primary position)	Clinical photographs	Upper lid retraction  Levator scarring  Compensatory levator  Retraction from restricted IR muscle Lower lid retraction  From proptosis  From IR recession surgery	Lid retraction from  Orbital fracture  Maxillary sinus atelectasis
Proptosis	Exophthalmometry		Fat expansion Muscle enlargement GC-induced lipogenesis	Orbital neoplasia Inflammation Hemorrhage/trauma GC-induced proptosis
Corneal exposure	Slit-lamp biomicroscope Fluorescein stain		Lid retraction Lacrimal gland inflammation	Dry eyes Corneal infection Eyelid margin disease

EUGOGO, European group on Graves' orbitopathy; GC, glucocorticoid; IR, inferior rectus.