Choice of therapy and criteria for assessing treatment outcome in thyroid-associated ophthalmopathy.

Treatment recommended for thyroid-associated ophthalmopathy varies with the particular expression of the disease in a given patient. Medical therapy may be beneficial in the early phase before extensive fibrosis of retro-ocular muscles and connective tissue is established. Although corticosteroids reliably suppress acute inflammatory changes, evidence supporting efficacy of plasmapheresis, immunosuppressive drugs, iodine-131 ablation, and radiotherapy is inconclusive. Surgery on eyelids, extraocular muscles, and orbit effectively rehabilitates most patients with even the most severe ophthalmopathy while having no effect on the underlying autoimmune process. Future research should include continued attempts to identify the putative target antigens in the orbit and to define the controls of glycosaminoglycan synthesis. Until prevention by immunologic or other medical means is attainable, surgery on orbit, muscles, and eyelids appears the most effective mode of treatment for correction of the functional and cosmetic consequences of the ophthalmopathy associated with autoimmune thyroid disease.