Graves' disease ophtalmopathy medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Treatment of ophthalmopathy depends on the phase and severity of the disease. It ranges from enhancement of tear-film quality and maintenance of ocular surface moisture for mild disease to intravenously administered pulse glucocorticoid therapy for severe and sight threatening disease.
Ophtalmopathy
- Treatment for ophthalmopathy depends on the phase and severity of the disease.
- It ranges from enhancement of tear-film quality and maintenance of ocular surface moisture for mild disease to intravenously administered pulse glucocorticoid therapy for severe and sight threatening disease.
The table below summarizes the treatment options for ophtalmopathy.[1][2][3][4][5]
| Severity | Therapy | Mechanism | Advantages/disadvantages | Common Doses |
|---|---|---|---|---|
| Mild active disease | Topical solutions Artificial tears Glucocorticoids Avoidance of wind, light, dust, smoke Elevation of head during sleep Avoidance of eye cosmetics Selenium |
Maintain tear film Reduce inflammation Reduces ocular surface desiccation, reduces irritation Reduces orbital congestion Reduces irritation Uncertain |
Rapid action, minimal side effects Rapid action, minimal side effects Benefits not yet confirmed Benefits not yet confirmed |
|
| Moderate or severe active disease | Systemic glucocorticoids Oral Intravenous |
Reduces inflammation and orbital congestion |
Hyperglycemia, hypertension, osteoporosis Rapid onset of anti-inflammatory effect, fewer side, liver damage |
Up to 100 mg of oral prednisone daily, followed by tapering of the dose Methylprednisolone, 500 mg/wk for 6 wk followed by 250 mg/wk for 6 wk |
| Orbital irradiation | Reduces inflammation | Can induce retinopathy | 2 Gy daily for 2 wk (20 Gy total) | |
| B-cell depletion | Reduces autoreactive B cells | Very expensive; risk of infection, cancer, allergic reaction | Two 1000-mg doses of intravenous rituximab 2 wks apart | |
| Emergency orbital decompression | Reduces orbital volume | |||
| Stable disease (inactive) | Orbital decompression (fat removal) | Reduces orbital volume | Postoperative diplopia, pain | |
| Bony decompression of the lateral and medial walls | Reduces proptosis by enlarging orbital space | Postoperative diplopia, pain, sinus bleeding, cerebrospinal fluid leak | ||
| Strabismus repair | Improves eye alignment, reduces diplopia | |||
| Eyelid repair | Improves appearance, reduces lagophthalmos and improves function |
References
- ↑ Weissel M (2011). "Selenium and the course of mild Graves' orbitopathy". N. Engl. J. Med. 365 (8): 769–70, author reply 770–1. doi:10.1056/NEJMc1107080#SA1. PMID 21864187.
- ↑ Zang S, Ponto KA, Kahaly GJ (2011). "Clinical review: Intravenous glucocorticoids for Graves' orbitopathy: efficacy and morbidity". J. Clin. Endocrinol. Metab. 96 (2): 320–32. doi:10.1210/jc.2010-1962. PMID 21239515.
- ↑ Bartalena L, Krassas GE, Wiersinga W, Marcocci C, Salvi M, Daumerie C, Bournaud C, Stahl M, Sassi L, Veronesi G, Azzolini C, Boboridis KG, Mourits MP, Soeters MR, Baldeschi L, Nardi M, Currò N, Boschi A, Bernard M, von Arx G (2012). "Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves' orbitopathy". J. Clin. Endocrinol. Metab. 97 (12): 4454–63. doi:10.1210/jc.2012-2389. PMID 23038682.
- ↑ Aktaran S, Akarsu E, Erbağci I, Araz M, Okumuş S, Kartal M (2007). "Comparison of intravenous methylprednisolone therapy vs. oral methylprednisolone therapy in patients with Graves' ophthalmopathy". Int. J. Clin. Pract. 61 (1): 45–51. doi:10.1111/j.1742-1241.2006.01004.x. PMID 16889639.
- ↑ Brent GA (2008). "Clinical practice. Graves' disease". N. Engl. J. Med. 358 (24): 2594–605. doi:10.1056/NEJMcp0801880. PMID 18550875.