[Endocrine ophthalmology. An overview of pathology, classification, and therapy]

A new uniform nomenclature will allow more accurate clinical study of endocrine ophthalmopathy, a disease that remains an enigma. Clinical eye disease develops in 30-60% of patients with Graves' disease, but the severe malignant form occurs in a maximum of 5%, and most of these latter patients have been rendered euthyroid or hypothyroid by treatment of the hyperthyroidism. Despite claims to the contrary, there is no convincing evidence that the mode of treatment (antithyroid drugs, surgery or radioiodine) has a bearing on the development of ophthalmopathy. Circulating fragments of the TSH-molecule, which produce swelling of retroorbital tissue, and as autoimmune processes of the delayed type are currently under consideration as causative factors. Medical treatment of endocrine ophthalmopathy has only a limited effect. In cases of rapid progression with deterioration of vision it is recommended that operative decompression, preferably into the maxillary and ethmoidal sinus, be performed without delay. Retroorbital administration of 2000 rad by a highly collimated megavoltage beam appears to be a valuable alternative to surgery.