Eye conditions Quiz: Ace Your Exams

A 52-year-old woman comes to her primary care physician's office for evaluation of anxiety, weight loss and blurry vision. The patient has been feeling irritable and “on edge” at work for months, and she has lost 13-lb over this same time period, despite maintaining her diet. The patient states that her eyes have been feeling “uncomfortable,” reporting excessive tearing and episodic double vision. She has no significant past medical history. Temperature is 37.4°C (99.3°F), pulse is 94/min, respirations are 15/min, and blood pressure is 142/94 mmHg. The patient appears anxious. Ocular examination reveals bilateral proptosis, excessive tearing, and periorbital edema. When the physician asks the patient to follow his finger as he moves it superiorly and inferiorly, the patient’s sclera can be observed above the iris when the patient's eyes track downward. Laboratory studies reveal an elevated free T3 and T4 level with an undetectable level of TSH. Which of the following best explains the underlying pathophysiology of this patient’s ocular findings?