Management of mild and moderate Graves' Orbitopathy

Purpose Management of Graves orbitopathy (GO) varies according to the level of its activity and its severity. For the activity evaluation, although no method is both specific and completely reliable, a simple office‐based tool is the Clinical Activity Score, which reflects the presence or absence of symptoms and signs that indicate inflammation. In addition, the severity of disease should be assessed by measuring exophthalmos, lid width, evaluating soft‐tissue involvement and extra‐ocular muscle function, and assessing corneal involvement and optic‐nerve involvement. Features of mild and moderate to severe GO will be presented. Results Specific treatments for GO vary depending on the severity of the disease. Mild GO usually does not require any treatment except for local measures ( ex lubrificants, ointments, dark lenses, and prisms to to reduce diplopia).However, in some patient quality of life is so impaired that treatment such as that for more severe GO might be suggested. Regular follow‐up every 3‐6 months is recommended, since progression of GO is observed in about 25% of the pats. Patients with moderate to severe with active disease (CAS>/=3) should be treated with immunosuppressive treatment modalities, while those with inactive GO may benefit from rehabilitative surgery. Conclusion The treatment of choice for moderate to severe GO is IV glucocorticoids +/‐ orbital radiation therapy, if GO is inactive, surgery as orbital decompression and /or squint surgery and/or eyelid surgery