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Table 7. GO Severity Assessment
Grade
a
Lid
retraction Soft tissues Proptosis
b
Diplopia
Corneal
exposure
Optic nerve
status
Mild <2 mm Mild
involvement
<3 mm Transient
or absent
Absent Normal
Moderate ≥2 mm Moderate
involvement
≥3 mm Inconstant Mild Normal
Severe ≥2 mm Severe
involvement
≥3 mm Constant Mild Normal
Sight
threatening
Severe
Compression
Upper limits of normal
African
American
F/M = 23/24 mm
White F/M = 19/21 mm
Asian F/M = 16/17 mm (ai) or 18.6 mm (Chinese)
a
Mild GO: patients whose features of GO have only a minor impact on daily life,
generally insufficient to justify immunosuppressive or surgical treatment.
Moderate-to-severe GO: patients without sight-threatening GO whose eye disease has
sufficient impact on daily life to justify the risks of immunosuppression (if active) or
surgical intervention (if inactive).
Sight-threatening GO: patients with dysthyroid optic neuropathy and/or corneal
breakdown. is category warrants immediate intervention.
b
Proptosis refers to the variation compared to the upper limit of normal for each race/
sex or the patient's baseline, if available.
Sources: Adapted from de Juan et al. Arch Intern Med. 1980;140:1230-1231, Sarinnapakorn et al.
J Med Assoc. ai 2007;90:679-683, Tsai et al. Eye (Lond) 2006;20:569-573 and Bartalena et al.
yroid 2008;18:333-346.