It may occur unilaterally or bilaterally and is often asymmetric. The most common cause of eyelid retraction is hyperthyroidism.
Symptoms are frequently worse in the morning upon awakening.
Exophthalmos may give rise to secondary lagophthalmos and may cause resistance to retropulsion of the globe. Extraocular muscles become infiltrated and fibrotic. If the cause of the inability of the patient to move their own eye is paretic, then the eye will move freely when the doctor attempts to move it. The infiltrated IR muscle can increase IOP significantly in upgaze be careful with IOP measurements. Patients may complain of diplopia in upgaze in asymmetric disease.