Thyroid-associated ophthalmopathy: pathogenesis and clinical management.

The pathogenesis of thyroid-associated ophthalmopathy is autoimmune. The questions to which answers are eagerly awaited are the identification of the autoantigen(s) and the definition of the autoimmune processes (cellular or humoral) responsible. Cellular and humoral immune responses and modulation by cytokines, against orbital tissues have been described. A link between the thyroid and the orbit seems inevitable, possibly in the form of a cross-reactive antigen, and top of the list of candidate antigens is the TSH receptor. Optimal treatment of TAO necessitates careful assessment. Thoughtful planning and timing and choice of intervention with conventional therapies, can lead to satisfactory results in the majority of cases. In addition to treating the severe complications, such as optic neuropathy, corneal exposure and muscle misalignment, corrective surgery to reconstruct the appearance of the patient's eyes should be made available.