Table 4.

Protocol to assess the severity of Graves' ophthalmopathy (EUGOGO). Some of the signs may be assessed by comparison with the image atlas provided by the EUGOGO (http://www.eugogo.eu/).

Soft tissues	Eyelid swelling  (i) Absent  (ii) Mild: none of the features defining moderate or severe swelling are present  (iii) Moderate: definite swelling but no lower eyelid festoons and in the upper eyelid the skin fold becomes angled on a 45° downgaze  (iv) Severe: lower eyelid festoons OR upper lid fold remains rounded on a 45° downgaze
	Eyelid erythema  (i) Absent  (ii) Present
	Conjunctival redness  (i) Absent  (ii) Mild: equivocal or minimal redness  (iii) Moderate: <50% of definite conjunctival redness  (iv) Severe: >50% of definite conjunctival redness
	Conjunctival edema  (i) Absent  (ii) Present: separation of conjunctiva from sclera present in >1/3 of the total height of the palpebral aperture or conjunctiva prolapsing anterior to grey line of eyelid
	Inflammation of caruncle or plica semilunaris  (i) Absent  (ii) Present: plica is prolapsed through closed eyelids or caruncle and/or plica are inflamed
Eyelid measurements	Palpebral aperture (mm)  Upper/lower lid retraction (mm)  Levator function (mm)  Lagophthalmos  (i) Absent  (ii) Present  Bell's phenomenon  (i) Absent  (ii) Present
Proptosis	Measurement with Hertel's exophthalmometer. Recording of intercanthal distance.
Ocular motility	Prism cover test  Monocular ductions  Head posture  Torsion  Field of binocular single vision
Cornea	Corneal integrity  (i) Normal  (ii) Punctate keratopathy  (iii) Ulcer  (iv) Perforation
Optic neuropathy	(i) Visual acuity (Logmar or Snellen)  (ii) Afferent pupil defect (present/absent)  (iii) Colour vision  (iv) Optic disc assessment: normal/atrophy/edema