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Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management.

Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC - J Ophthalmol (2015)

Bottom Line: The VISA (vision, inflammation, strabismus, and appearance), and the European Group of Graves' Orbitopathy (EUGOGO) classifications are the two widely used grading systems conceived to assess the activity and severity of GO and guide the therapeutic decision making.Current treatments are reviewed and management guidelines according to the severity and activity of the disease are provided.New treatment modalities such as specific monoclonal antibodies, TSH-R antagonists, and other immunomodulatory agents show a promising outcome for GO patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Clínica Universidad de Navarra, Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain.

ABSTRACT
Graves' ophthalmopathy (GO) is an autoimmune inflammatory disorder associated with thyroid disease which affects ocular and orbital tissues. GO follows a biphasic course in which an initial active phase of progression is followed by a subsequent partial regression and a static inactive phase. Although the majority of GO patients have a mild, self-limiting, and nonprogressive ocular involvement, about 3-7% of GO patients exhibit a severe sight-threatening form of the disease due to corneal exposure or compressive optic neuropathy. An appropriate assessment of both severity and activity of the disease warrants an adequate treatment. The VISA (vision, inflammation, strabismus, and appearance), and the European Group of Graves' Orbitopathy (EUGOGO) classifications are the two widely used grading systems conceived to assess the activity and severity of GO and guide the therapeutic decision making. A critical analysis of classification, assessment, and management systems is reported. A simplified "GO activity assessment checklist" for routine clinical practice is proposed. Current treatments are reviewed and management guidelines according to the severity and activity of the disease are provided. New treatment modalities such as specific monoclonal antibodies, TSH-R antagonists, and other immunomodulatory agents show a promising outcome for GO patients.

No MeSH data available.


Related in: MedlinePlus

Chemosis. Notice the conjunctiva separated from the sclera and behind the grey line (arrows) and diffuse conjunctival redness.
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fig2: Chemosis. Notice the conjunctiva separated from the sclera and behind the grey line (arrows) and diffuse conjunctival redness.

Mentions: Soft tissue inflammation/congestion (I) evaluation is graded according to the worst score for the eye or the eyelid with the Inflammatory Index (Table 3). Symptoms include orbital ache at rest or with ocular movement and diurnal variation (inflammation worsening with the head dependent after sleep or worsening of diplopia at morning). Signs include caruncular edema, chemosis, conjuntival redness, lid redness, and lid edema. Chemosis is graded as 1 if the conjunctiva lies behind the grey line of the lid (Figure 2) and as 2 if it extends anterior to the grey line. Lid edema is graded as 1 if it is present but not causing overhanging of the tissues and as 2 if it causes a roll in the lid skin including festoons in the lower lid. Cases with moderate inflammatory index (less than 4 of 10) are managed conservatively. Patients with high scores (above 5 of 10) or with subjective or objective evidence of progression in the inflammation are offered a more aggressive therapy.


Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management.

Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC - J Ophthalmol (2015)

Chemosis. Notice the conjunctiva separated from the sclera and behind the grey line (arrows) and diffuse conjunctival redness.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4553342&req=5

fig2: Chemosis. Notice the conjunctiva separated from the sclera and behind the grey line (arrows) and diffuse conjunctival redness.
Mentions: Soft tissue inflammation/congestion (I) evaluation is graded according to the worst score for the eye or the eyelid with the Inflammatory Index (Table 3). Symptoms include orbital ache at rest or with ocular movement and diurnal variation (inflammation worsening with the head dependent after sleep or worsening of diplopia at morning). Signs include caruncular edema, chemosis, conjuntival redness, lid redness, and lid edema. Chemosis is graded as 1 if the conjunctiva lies behind the grey line of the lid (Figure 2) and as 2 if it extends anterior to the grey line. Lid edema is graded as 1 if it is present but not causing overhanging of the tissues and as 2 if it causes a roll in the lid skin including festoons in the lower lid. Cases with moderate inflammatory index (less than 4 of 10) are managed conservatively. Patients with high scores (above 5 of 10) or with subjective or objective evidence of progression in the inflammation are offered a more aggressive therapy.

Bottom Line: The VISA (vision, inflammation, strabismus, and appearance), and the European Group of Graves' Orbitopathy (EUGOGO) classifications are the two widely used grading systems conceived to assess the activity and severity of GO and guide the therapeutic decision making.Current treatments are reviewed and management guidelines according to the severity and activity of the disease are provided.New treatment modalities such as specific monoclonal antibodies, TSH-R antagonists, and other immunomodulatory agents show a promising outcome for GO patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Clínica Universidad de Navarra, Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain.

ABSTRACT
Graves' ophthalmopathy (GO) is an autoimmune inflammatory disorder associated with thyroid disease which affects ocular and orbital tissues. GO follows a biphasic course in which an initial active phase of progression is followed by a subsequent partial regression and a static inactive phase. Although the majority of GO patients have a mild, self-limiting, and nonprogressive ocular involvement, about 3-7% of GO patients exhibit a severe sight-threatening form of the disease due to corneal exposure or compressive optic neuropathy. An appropriate assessment of both severity and activity of the disease warrants an adequate treatment. The VISA (vision, inflammation, strabismus, and appearance), and the European Group of Graves' Orbitopathy (EUGOGO) classifications are the two widely used grading systems conceived to assess the activity and severity of GO and guide the therapeutic decision making. A critical analysis of classification, assessment, and management systems is reported. A simplified "GO activity assessment checklist" for routine clinical practice is proposed. Current treatments are reviewed and management guidelines according to the severity and activity of the disease are provided. New treatment modalities such as specific monoclonal antibodies, TSH-R antagonists, and other immunomodulatory agents show a promising outcome for GO patients.

No MeSH data available.


Related in: MedlinePlus