Treatment of Graves' Ophthalmopathy

ABSTRACT

Graves' ophthalmopathy (GO) is an autoimmune disease associated with orbital inflammation and fibrosis which can result in lid retraction, soft tissue swelling, and proptosis. Treatment should rely on a thorough assessment of the activity and severity of GO. Control of risk factors for GO progression and topical treatments for dry eye are recommended for all patients. In mild GO, a careful observation is usually sufficient. In moderate-to-severe and active GO, high-dose intravenous glucocorticoids can be considered an initial treatment. The most common schedule for intravenous glucocorticoids is a cumulative dose of 4.5 g of methylprednisolone, divided into 12 weekly infusions (6 weekly infusions of 0.5 g, followed by 6 weekly infusions of 0.25 g). Orbital radiation has been shown to be an effective secondary treatment in patients with active GO unresponsive to intravenous glucocorticoids. Rehabilitative surgery is needed in patients with GO when the disease is associated with a significant impact on quality of life or visual function after the disease has been inactive for at least 6 months.