Management of Mild Graves’ Orbitopathy

Mild GO is usually diagnosed based on the assessment of soft tissue inflammation, in particular eyelid and conjunctival edema and hyperaemia, mild proptosis ( 3 mm above normal for race and gender) and only minor, if any, eye muscle involvement [1] (fig. 1) [see chapter by Dickinson, pp. 1–25]. In a proportion of patients, eye muscles may be significantly involved [2], although motility tests may not reveal the actual degree of inflammation unless orbital imaging is performed [3, 4]. Orbital changes in mild GO are sometimes uniquely limited to eye muscles in the absence of soft tissue inflammation [5]. Recent work has shown that eye muscle enlargement by itself may be more significantly correlated to proptosis than retroocular fat and connective tissue hypertrophy [6].