title: Graves orbitopathy: update on diagnosis and therapy.
abstract: Graves orbitopathy (GO) is an autoimmune disorder representing the most frequent extrathyroidal manifestation of Graves disease. It is rare, with an age-adjusted incidence of approximately 16.0 cases per 100,000 population per year in women and 2.9 cases per 100,000 population per year in men. GO is an inflammatory process characterized by edema and inflammation of the extraocular muscles and an increase in orbital connective tissue and fat. Despite recent progress in the understanding of its pathogenesis, GO often remains a major diagnostic and therapeutic challenge. It has become increasingly important to classify patients into categories based on disease activity at initial presentation. A Hertel exophthalmometer measurement of >2 mm above normal for race usually categorizes a patient as having moderate-to-severe GO. Encouraging smoking cessation and achieving euthyroidism in the individual patient are important. Simple treatment measures such as lubricants for lid retraction, nocturnal ointments for incomplete eye closure, prisms in diplopia, or botulinum toxin injections for upper-lid retraction can be effective in mild cases of GO. Glucocorticoids, orbital radiotherapy, and decompression/rehabilitative surgery are generally indicated for moderate-to-severe GO and for sight-threatening optic neuropathy. Future therapies, including rituximab aimed at treating the molecular and immunological basis of GO, are under investigation and hold promise for the future.
authors.affiliation: From the Departments of Medicine, Radiology/Nuclear Medicine, Neurology, and Ophthalmology, University of Mississippi Medical Center, Jackson, the Department of Ophthalmology, GV (Sonny) Montgomery VA Medical Center, Jackson, Mississippi, and the Department of Medicine/Endocrinology, Louisiana State University Health Sciences Center, New Orleans.
authors.forename: Eugen
authors.initials: E
authors.lastname: Melcescu
authors.forename: William B
authors.initials: WB
authors.lastname: Horton
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
authors.forename: Vani
authors.initials: V
authors.lastname: Vijayakumar
authors.forename: James J
authors.initials: JJ
authors.lastname: Corbett
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Crowder
authors.forename: Karen T
authors.initials: KT
authors.lastname: Pitman
authors.forename: Gabriel I
authors.initials: GI
authors.lastname: Uwaifo
authors.forename: Christian A
authors.initials: CA
authors.lastname: Koch
mesh_terms: D019299:Decompression, Surgical; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D049970:Graves Ophthalmopathy / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D054327:Lubricants; D008297:Male; D009824:Ointments; D009916:Orbital Diseases / Q000175:diagnosis* / Q000628:therapy*; D011878:Radiotherapy; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids; D054327:Lubricants; D009824:Ointments