Patient presents with signs and symptoms consistent with Graves ophthalmopathy, also known as thyroid eye disease.  Clinical findings include proptosis, exophthalmos, lid retraction, periorbital edema, conjunctival injection, and restrictive extraocular myopathy affecting eye movements.  Patient reports diplopia, specifically while looking up or to the sides.  Symptoms of ocular discomfort, such as dryness, grittiness, burning, and photophobia, are also reported.  Patient has a known history of Graves disease, with laboratory results confirming hyperthyroidism.  Current thyroid stimulating hormone TSH levels are suppressed.  Assessment suggests moderate severity Graves ophthalmopathy, Clinical Activity Score CAS less than 3.  Current management focuses on symptom control, including artificial tears for dry eyes and protective eyewear for light sensitivity.  Patient education provided regarding smoking cessation, importance of controlling thyroid function, and potential risks and benefits of treatment options, including corticosteroids, orbital decompression surgery, and immunomodulatory therapy.  Follow-up appointment scheduled to monitor disease progression and adjust treatment as needed.  ICD-10 code E05.0 for thyrotoxicosis with ophthalmopathy is documented.  Differential diagnoses considered included orbital pseudotumor and other inflammatory orbital diseases.  Referral to ophthalmology for further evaluation and management is planned.