Immunosuppressive treatment of Graves' ophthalmopathy

Steroids or orbital irradiation are effective in approximately 60% of patients with severe Graves' ophthalmopathy; the improvement of proptosis and extraocular muscle dysfunction, however, is limited. Better results are obtained by the combination of orbital irradiation and systemic steroids. Cyclosporine alone is not very effective, but the combination of cyclosporine and low-dose prednisone (administered after a previous insufficient response to high-dose steroids) is effective in 59% of cases. Disease activity rather than disease duration is probably the main determinant of the therapeutic outcome.