A clinical activity score of 3 or more is predictive of a patient’s response to immunosuppressive therapy. Each component of the activity score is worth one point.
| Components of the Clinical Activity Score |
| Spontaneous retrobular pain |
| Pain with eye movement |
| Redness of the eyelids |
| Redness of the conjunctiva |
| Swelling of the eyelids |
| Swelling of the caruncle |
| Conjunctival edema (chemosis) |
The other option is radioiodine, but 15% of people have their ophthalmopathy get worse.
A randomised trial comparing orbital radiotherapy with oral glucocorticoids showed a similar rate of remission with approximately 50% of eye disease improving. While there is no universally agreed treatment schedule for sight-threatening dysthyroid optic neuropathy a common approach is intravenous glucocorticoids with prompt surgical orbital decompression if there is no clinical improvement.
Risk factors for Grave’s opthalmopathy following radioiodine include cigarette smoking, severe hyperthyroidism, high levels of thyrotropin receptor antibodies and uncontrolled hypothyroidism.
Grave’s Ophthalmopathy is usually bilateral but can be unilateral or asymmetrical. It may precede or follow hyperthyroidism but most often develops during the period of thyrotoxicosis. Several other conditions that can cause similar bilateral or unilateral appearance include: Cushing’s syndrome, obesity, orbital pseuotumour, idiopathic myositis and cellulitis, primary or metastatic orbital tumours, vascular conditions such as aneurysms and granulomatous diseases.
