Management of Graves’ Ophthalmopathy: Reality and Perspectives1
Luigi Bartalena,
Aldo Pinchera and
Claudio Marcocci
Dipartimento di Endocrinologia e Metabolismo, Ortopedia e
Traumatologia, Medicina del Lavoro, University of Pisa, 56124 Pisa,
Italy
Graves’ ophthalmopathy is an debilitating disease impairingthe
quality of life of affected individuals. Despite recentprogress in the
understanding of its pathogenesis, treatmentis often not satisfactory.
In mild cases, local therapeuticmeasures (artificial tears and
ointments, sunglasses, nocturnaltaping of the eyes, prisms) can
control symptoms and signs.In severe forms of the disease (3–5%),
aggressive measuresare required. If the disease is active, high-dose
glucocorticoidsand/or orbital radiotherapy, or orbital decompression
representthe mainstay of treatment. If the disease is severe but
inactive,orbital decompression is preferred. Novel treatments such as
somatostatinanalogs or intravenous immunoglobulins are under
evaluation.Rehabilitative (extraocular muscle or eyelid) surgery is
oftenneeded after treatment and inactivation of eye disease.
Correctionof both hyper- and hypothyroidism is crucial for the
ophthalmopathy.Antithyroid drugs and thyroidectomy do not influence
the courseof the ophthalmopathy, whereas radioiodine treatment may
causethe progression of preexisting ophthalmopathy, especially in
smokers.The exacerbation, however, is prevented by glucocorticoids.In
addition, thyroid ablation may prove beneficial for the ophthalmopathy
inview of the pathogenetic model relating eye disease to autoimmune
reactionsdirected against antigens shared by the thyroid and the
orbit.
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