Viral conjunctivitis interfering with the clinical activity score and management of thyroid ophthalmopathy.
BACKGROUND
The management of Graves' ophthalmopathy is shared between endocrinologists and ophthalmologists. Assessment and treatment of the active inflammatory stage is based on the clinical activity and disease severity scores, often without detailed eye examination by the treating endocrinologist.


METHODS
We report a case of acute viral keratoconjunctivitis occurring during immunosuppressive treatment for Graves' ophthalmopathy which masked the signs, symptoms and response to treatment of the orbitopathy, posing a differential diagnostic challenge.


RESULTS
The apparent worsening of the ophthalmopathy and the increased clinical activity score led the treating endocrinologist to alter the management decisions. Ophthalmic examination confirmed the diagnosis of viral keratoconjunctivitis and immunosuppressive treatment was continued with significant final improvement of Graves' ophthalmopathy.


CONCLUSIONS
Ocular surface conditions, unrecognised by the treating physician, may complicate the assessment of thyroid ophthalmopathy when detailed eye examination is not performed. The diagnostic challenge of Graves' ophthalmopathy requires a combined approach by an endocrinologist and an ophthalmologist working as a team.
Boboridis
K G
KG
Department of Ophthalmology, Aristotle University of Thessaloniki, Greece. kosbob@otenet.gr
Konstas
A G P
AG
Krassas
G E
GE
Georgiadis
N S
NS
D000208:Acute Disease; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003236:Conjunctivitis, Viral / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000998:Antiviral Agents; D007166:Immunosuppressive Agents