[Conservative therapy in endocrine orbitopathy: "State of the art"]

This review describes the state of the art of the conservative therapeutical approach of thyroid associated eye disease. Radiotherapy, surgery and ablative therapy of thyroid ophthalmopathy are discussed elsewhere in this issue of Acta Med Austriaca. All forms of therapy have to be adjusted to the severeness of the eye disease. The assessment of the severeness of this ailment can be difficult. Therefore, the impact of scoring systems like the "Clinical Activity Score" is pointed out. Treatment of thyroid dysfunction is the widely accepted first therapeutic measure. Additional supportive local therapy is usually sufficient in patients with only mild activity of endocrine ophthalmopathy. Glucocorticoids applied via different routes in various dose regimens are the therapy of first choice in (moderately) severe forms of the disease. Reported response rates for the oral form of therapy are about 63%, for the intravenously applied very high doses (given only in very severe forms of the disease) nearly 77%. Cyclosporin has been shown to be more efficient in combination with oral glucocorticoids in patients with moderately severe eye disease than glucocorticoids alone. Patients need a close follow up since both drugs have considerable side effects. An alternative treatment with high-dose intravenous immunoglobulins seems to have less side effects, but has the disadvantage of bearing the danger of serious infections as all plasma derived products and of being extremely expensive. Finally, preliminary data of new treatment modalities with the immunomodulators pentoxifylline and methotrexat are presented. These drugs have been tested so far with good success in patients with severe endocrine ophthalmopathy and unresponsive to other forms of treatment.