Table 1.

Classification systems used for Graves’ ophthalmopathy

NOSPECS

Class 0: No signs or symptoms

Class 1: Only signs (limited to upper lid retraction and stare, with or without lid lag)

Class 2: Soft tissue involvement (edema of conjunctivae and lids, conjunctival injection, etc)

Class 3: Proptosis

Class 4: Extraocular muscle involvement (usually with diplopia)

Class 5: Corneal involvement (primarily due to lagophthalmos)

Class 6: Sight loss (due to optic nerve involvement)

VISA

Vision loss (optic neuropathy)

Inflammation/congestion and activity in TED

Strabismus/motility

Appearance/exposure

CAS

Pain

1: Painful, oppressive feeling on or behind the globe during the last 4 weeks

2: Pain on attempted up, side, or down gaze during the last 4 weeks

Redness

3: Redness of the eyelid(s)

4: Diffuse redness of the conjunctiva, covering at least one quadrant

Swelling

5: Swelling of the eyelid(s)

6: Chemosis

7: Swollen caruncle

8: Increase of proptosis of >2 mm or more during a period between 1 month and 3 months

Impaired function

9: Decrease in eye movements in any direction greater than or equal to 5° during a period of 1–3 months

10: Decrease in visual acuity of greater than or equal to one line on the Snellen chart (using a pinhole) during a period of 1–3 months

Notes: For each of the signs present, one point is given. The sum of these points defines the activity score.

Abbreviations: TED, thyroid eye disease; CAS, Clinical Activity Score.