The percentage of people unlucky enough to develop Graves orbitopathy varies from report to report, from 25–30% to 60%, and most patients find it more problematic than the toxic thyroid symptoms.
Mild, typical symptoms are watery, gritty feeling eyes and swelling of the lids from the antibody attack, and often the cholinergic effects of high thyroid hormones themselves—chiefly lid lag. More serious symptoms include extrusion of the eyeballs forward in the orbits (exophthalmos, a.k.a. proptosis) and some visual field defects for the unlucky few (5% or less).
I have periorbital swelling, swelling of the ethmoid sinuses between the eyes, tearing, grittiness, redness, mild lid lag in the right eye and restriction of the upgaze in my right eye. Also when I look to the right, I see double.
The ophthalmologist tested my vision carefully and found no defects and saw "nothing too scary." He claims that, at 22 and 23 mm, my eyeballs are on the upper end of normal (16mm is typical) , and probably a little proptotic. I have always had prominent eyes, though, and no one thinks I look "bug-eyed" just yet. The double vision is only at the periphery, so I can still drive.
I go back in 3 months for a follow-up exam, including my visual fields again.
Man, I felt like giant mole, walking out of the eye doctor's office, stunned by magnesium-bright sunlight.
One of the problems with my primary physician's not suspecting Graves' disease was that my swelling seemed to be unilateral and she could discern no lid lag (a spastic delay in lid lowering when the eye looks down). But I did have lid lag, albeit mild, and she simply was unaware that Graves' orbitopathy freqently affects one eye much worse than the other.
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