Graves' disease ophtalmopathy medical therapy: Difference between revisions
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Created page with "__NOTOC__ {{Graves' disease}} {{CMG}},{{AE}}{{MehdiP}} ==Overview== ==Ophtalmopathy== *Treatment for ophthalmopathy depends on the phase and severity of the disease. *It is r..." |
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The table below summarizes the treatment options for ophtalmopathy. | The table below summarizes the treatment options for ophtalmopathy. | ||
{| style="border: 0px; font-size: 80%; margin: 3px;" align=center | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Severity}} | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Therapy}} | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Mechanism}} | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Advantages/disadvantages}} | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 | {{fontcolor|#FFFFFF|Common Doses}} | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Mild active disease}} | |||
| style="background: #F5F5F5; padding: 5px 5px;" rowspan=1 colspan=1 | Topical solutions <br>Artificial tears<br>Glucocorticoids<br>Avoidance of wind, light, dust, smoke<br>Elevation of head during sleep<br>Avoidance of eye cosmetics<br>Selenium | |||
| style="background: #F5F5F5; padding: 5px 5px;" rowspan=1 colspan=1 | <br>Maintain tear film<br>Reduce inflammation<br>Reduces ocular surface desiccation, reduces irritation<br>Reduces orbital congestion<br>Reduces irritation<br>Uncertain | |||
| style="background: #F5F5F5; padding: 5px 5px;" rowspan=1 colspan=1 | Rapid action, minimal side effects<br>Rapid action, minimal side effects<br> <br>Benefits not yet confirmed<br>Benefits not yet confirmed<br> | |||
| style="background: #F5F5F5; padding: 5px 5px;" rowspan=1 colspan=1 | | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=4 colspan=1 |{{fontcolor|#FFFFFF|Moderate or severe active disease}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Systemic glucocorticoids <br>Oral<br>Intravenous | |||
| style="padding: 5px 5px; background: #F5F5F5;" |<br>Reduce inflammation and orbital congestion <br>Reduce inflammation and orbital congestion | |||
| style="padding: 5px 5px; background: #F5F5F5;" |<br>Hyperglycemia, hypertension, osteoporosis<br>Rapid onset of anti-inflammatory effect, fewer side, liver damage | |||
| style="padding: 5px 5px; background: #F5F5F5;" |<br>Up to 100 mg of oral prednisone daily, followed by tapering of the dose<br>Methylprednisolone, 500 mg/wk for 6 wk followed by 250 mg/wk for 6 wk | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Orbital irradiation | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Reduces inflammation | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Can induce retinopathy | |||
| style="padding: 5px 5px; background: #F5F5F5;" |2 Gy daily for 2 wk (20 Gy total) | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |B-cell depletion | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Reduces autoreactive B cells | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Very expensive; risks of infection, cancer, allergic reaction | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Two 1000-mg doses of intravenous rituximab 2 wk apart | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Emergency orbital decompression | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Reduces orbital volume | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| style="background: #4479BA; padding: 5px 5px;" rowspan=4 colspan=1 |{{fontcolor|#FFFFFF|Stable disease (inactive)}} | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Orbital decompression (fat removal) | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Reduces orbital volume | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Postoperative diplopia, pain | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Bony decompression of the lateral and medial walls | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Reduces proptosis by enlarging orbital space | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Postoperative diplopia, pain, sinus bleeding, cerebrospinal fluid leak | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Strabismus repair | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Improves eye alignment, reduces diplopia | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Eyelid repair | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Improves appearance, reduces lagophthalmos and improves function | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|} | |||
Revision as of 21:17, 20 December 2016
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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
Ophtalmopathy
- Treatment for ophthalmopathy depends on the phase and severity of the disease.
- It is ranged 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.
| 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 |
Reduce inflammation and orbital congestion Reduce 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; risks of infection, cancer, allergic reaction | Two 1000-mg doses of intravenous rituximab 2 wk 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 |