Management of Graves’ Ophthalmopathy: Reality and Perspectives*

Abstract

Graves' ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In mild cases, local therapeutic measures (artificial tears and ointments, sunglasses, nocturnal taping of the eyes, prisms) can control symptoms and signs. In severe forms of the disease (3-5%), aggressive measures are required. If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment. If the disease is severe but inactive, orbital decompression is preferred. Novel treatments such as somatostatin analogs or intravenous immunoglobulins are under evaluation. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease. Correction of both hyper- and hypothyroidism is crucial for the ophthalmopathy. Antithyroid drugs and thyroidectomy do not influence the course of the ophthalmopathy, whereas radioiodine treatment may cause the progression of preexisting ophthalmopathy, especially in smokers. The exacerbation, however, is prevented by glucocorticoids. In addition, thyroid ablation may prove beneficial for the ophthalmopathy in view of the pathogenetic model relating eye disease to autoimmune reactions directed against antigens shared by the thyroid and the orbit.

Novel Approaches to the Management of Graves` Ophthalmopathy

“…They have been administered via systemic (mainly oral until 15 years ago) or local (subconjunctival or retrobulbar) routes 7 . Oral glucocorticoids provide overall favorable responses in slightly more than 60% of patients, whereas the local route is associated with beneficial effects only in about 40% of cases 1 . They are mostly effective in patients with severe and active florid eye disease.…”

“…Graves' ophthalmopathy (GO) is the complex of ocular signs and symptoms often present in Graves' disease; similar eye involvement can, however, less frequently be observed in patients with Hashimoto's thyroiditis or in subjects with no apparent thyroid abnormalities (socalled Euthyroid Graves' Disease) 1 . In most cases, ocular involment is nonsevere, but 3-5% of cases have severe and progressive ocular manifestations 1 .…”

“…In most cases, ocular involment is nonsevere, but 3-5% of cases have severe and progressive ocular manifestations 1 . It is noteworthy that the quality of life of affected individuals is markedly impaired not only in severe ophthalmopathy but also in nonsevere eye disease 2 .…”

“…This is because currently available methods of treatment frequently result in a partial or absent response of the ophthalmopathy. The unfavorable outcome can partly be explained by selection of patients because longstanding and inactive GO is unlikely to show relevant and substantial changes in response to whatever medical treatment, while results are more likely to be favorable in recent-onset and active eye disease 1 .…”

“…They have recently been extensively reviewed 1,4 . The aim of the present article is to analyze novel treatments (or novel modalities of established treatments) currently under investigation as well as therapeutic and preventive perspectives for this disease.…”