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OCR: en in Ophthalmoplegia is a more severe eye Ind Graves' disease and first affects upward gaze, and outward gaze. Later, upward and inwa ffected, in lateral, medial and downward gaze, are ision, that order. Patients complain of double hey find particularly on looking upwards, which it in more unpleasant than normal. The de the upward gaze is largely due to tethering ibrosis of muscles below the globe, particularly to lobe to be the inferior rectus which may cause th deviated downwards (Fig. 17.35).