In Graves ophthalmopathy the volume of the retro-orbital connective tissues and extra-ocular muscles is increased as a result of several causes
(1) marked infiltration of the retro-orbital space by mononuclear cells, predominantly T cells
(2) inflammatory edema and swelling of extra-ocular muscles;
(3) accumulation of extracellular matrix components, specifically hydrophilic glycosaminoglycans such as hyaluronic acid and chondroitin sulfate;
(4) increased numbers of adipocytes (fatty infiltration).
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