Abstract
Patients with serious inflammatory Graves' ophthalmopathy should be treated with anti-inflammatory drugs or radiotherapy to prevent complications like fibrosis, while those with non-inflammatory ophthalmopathy may be treated by surgery immediately. It is often difficult, however, to distinguish inflammatory from non-inflammatory Graves' disease. We therefore present a simple clinical classification here to differentiate between these two conditions. This classification is based on the classical signs of inflammation--pain, redness, swelling, and impaired function. After two consecutive clinical examinations an 'activity score' can be determined, ranging from 0 to 10 points. In a retrospective study testing the efficacy of this classification we found that patients with an activity score of 3 or more at the beginning of therapy responded well to anti-inflammatory drugs, while those with a lower activity score mostly did not. Comparing the pretreatment activity score with the degree of enlargement of the extraocular muscles on the CT scan, we found a significant correlation between these two parameters: the higher the activity score, the more the enlargement of the muscles. We conclude that this classification facilitates the proper selection of patients for treatment.
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- Day R. M., Carroll F. D. Corticosteroids in the treatment of optic nerve involvement associated with thyroid dysfunction. Trans Am Ophthalmol Soc. 1967;65:41–51. [PMC free article] [PubMed] [Google Scholar]
- Frueh B. R., Musch D. C., Grill R., Garber F. W., Hamby S. Orbital compliance in Graves' eye disease. Ophthalmology. 1985 May;92(5):657–665. doi: 10.1016/s0161-6420(85)33990-8. [DOI] [PubMed] [Google Scholar]
- Gilbard J. P., Farris R. L. Ocular surface drying and tear film osmolarity in thyroid eye disease. Acta Ophthalmol (Copenh) 1983 Feb;61(1):108–116. doi: 10.1111/j.1755-3768.1983.tb01401.x. [DOI] [PubMed] [Google Scholar]
- Gorman C. Ophthalmopathy of Graves' disease. N Engl J Med. 1983 Feb 24;308(8):453–454. doi: 10.1056/NEJM198302243080811. [DOI] [PubMed] [Google Scholar]
- Hurbli T., Char D. H., Harris J., Weaver K., Greenspan F., Sheline G. Radiation therapy for thyroid eye diseases. Am J Ophthalmol. 1985 Jun 15;99(6):633–637. doi: 10.1016/s0002-9394(14)76027-1. [DOI] [PubMed] [Google Scholar]
- Jacobson D. H., Gorman C. A. Endocrine ophthalmopathy: current ideas concerning etiology, pathogenesis, and treatment. Endocr Rev. 1984 Spring;5(2):200–220. doi: 10.1210/edrv-5-2-200. [DOI] [PubMed] [Google Scholar]
- Kahaly G., Schrezenmeir J., Krause U., Schweikert B., Meuer S., Muller W., Dennebaum R., Beyer J. Ciclosporin and prednisone v. prednisone in treatment of Graves' ophthalmopathy: a controlled, randomized and prospective study. Eur J Clin Invest. 1986 Oct;16(5):415–422. doi: 10.1111/j.1365-2362.1986.tb01016.x. [DOI] [PubMed] [Google Scholar]
- Sergott R. C., Felberg N. T., Savino P. J., Blizzard J. J., Schatz N. J. Graves' ophthalmopathy--immunologic parameters related to corticosteroid therapy. Invest Ophthalmol Vis Sci. 1981 Feb;20(2):173–182. [PubMed] [Google Scholar]
- Van Dyk H. J. Orbital Graves' disease. A modification of the "NO SPECS" classification. Ophthalmology. 1981 Jun;88(6):479–483. [PubMed] [Google Scholar]
- Werner S. C. Modification of the classification of the eye changes of Graves' disease. Am J Ophthalmol. 1977 May;83(5):725–727. doi: 10.1016/0002-9394(77)90140-4. [DOI] [PubMed] [Google Scholar]