Clinical features of dysthyroid optic neuropathy: a European Group on Graves' Orbitopathy (EUGOGO) survey.
BACKGROUND
This study was performed to determine clinical features of dysthyroid optic neuropathy (DON) across Europe.


METHODS
Forty seven patients with DON presented to seven European centres during one year. Local protocols for thyroid status, ophthalmic examination and further investigation were used. Each eye was classified as having definite, equivocal, or no DON.


RESULTS
Graves' hyperthyroidism occurred in the majority; 20% had received radioiodine. Of 94 eyes, 55 had definite and 17 equivocal DON. Median Clinical Activity Score was 4/7 but 25% scored 3 or less, indicating severe inflammation was not essential. Best corrected visual acuity was 6/9 (Snellen) or worse in 75% of DON eyes. Colour vision was reduced in 33 eyes, of which all but one had DON. Half of the DON eyes had normal optic disc appearance. In DON eyes proptosis was > 21 mm (significant) in 66% and visual fields abnormal in 71%. Orbital imaging showed apical muscle crowding in 88% of DON patients. Optic nerve stretch and fat prolapse were infrequently reported.


CONCLUSIONS
Patients with DON may not have severe proptosis and orbital inflammation. Optic disc swelling, impaired colour vision and radiological evidence of apical optic nerve compression are the most useful clinical features in this series.
McKeag
David
D
Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff CF 4 4XN, UK.
Lane
Carol
C
Lazarus
John H
JH
Baldeschi
Lelio
L
Boboridis
Kostas
K
Dickinson
A Jane
AJ
Hullo
A Iain
AI
Kahaly
George
G
Krassas
Gerry
G
Marcocci
Claudio
C
Marinò
Michele
M
Mourits
Maarten P
MP
Nardi
Marco
M
Neoh
Christopher
C
Orgiazzi
Jacques
J
Perros
Petros
P
Pinchera
Aldo
A
Pitz
Susanne
S
Prummel
Mark F
MF
Sartini
Maria S
MS
Wiersinga
Wilmar M
WM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003117:Color Vision Defects / Q000209:etiology; D003941:Diagnostic Techniques, Ophthalmological; D004172:Diplopia / Q000209:etiology; D005260:Female; D049970:Graves Ophthalmopathy / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index; D014792:Visual Acuity