Table 1.
Activity and Severity Definitions for Patients with Thyroid Eye Disease
| A. Activity |
| 1. Clinical activity score |
| The 7-item CAS is shown hereunder. Each item scores 1 point if presenta |
| Spontaneous retrobulbar pain |
| Pain on attempted up or lateral gaze |
| Redness of the eyelids |
| Redness of the conjunctiva |
| Swelling of the eyelids |
| Inflammation of the caruncle and/or plica (Fig. 2b) |
| Conjunctival edema, also known as chemosis (Fig. 2c) |
| 2. Active TED |
| A CAS ≥3/7 usually implies active TED. A history or documentation of progression of TED based on subjective or objective worsening of vision, soft tissue inflammation, motility, or proptosis is suggestive of active TED independently of the CAS |
| B. Severity |
| 1. Sight-threatening TED |
| Patients with DON and/or corneal breakdown and/or globe subluxation (Fig. 2f) |
| 2. Moderate-to-severe TED |
| Patients without sight-threatening disease whose eye disease has sufficient impact on daily life to justify the risks of medical or surgical intervention. Patients with moderate-to-severe TED usually have any one or more of the following: lid retraction ≥2 mm, moderate or severe soft tissue involvement, proptosis ≥3 mm above normal for race and sex, or diplopia (Gorman score 2–3). |
| 3. Mild TED |
| Patients whose features of TED have only a minor impact on daily life insufficient to justify immunosuppressive or surgical treatment. They usually have only one or more of the following: minor lid retraction (<2 mm), mild soft tissue involvement, proptosis <3 mm above normal for race and sex, transient or no diplopia, and corneal exposure responsive to lubricants. |
a
A 10-item CAS is also sometimes used and includes additional points for increase of at least 2 mm in proptosis, decrease of at least 8° in any duction, and decrease of visual acuity by two lines. A limitation of the 10-item CAS is that it requires an earlier assessment of the mentioned measures, which is usually unavailable on first consultation. See Bartalena et al.19
CAS, clinical activity score; DON, dysthyroid optic neuropathy; TED, thyroid eye disease.