The management of ophthalmic Graves' disease

From a series of 124 consecutive patients, parameters were developed in the management of Graves' disease. Patients who were stable with symptomatic treatment were observed and followed. Oral steroids, 40 to 80 mg prednisone daily, were moderately effective in reducing progressive soft tissue inflammatory signs, but were less effective in controlling myopathy and lid retraction. Radiotherapy, 1000 rad from each lateral port, was most effective in halting the progressive inflammatory component, particularly in those who had a recent rapid rate of change. Dysthyroid optic neuropathy required high dose steroids; if it was not effective, decompression of the orbit was carried out. Once the disease became stable, myopathy, lid retraction, and exophthalmos were surgically treated on an elective basis. The techniques utilized were tarsorrhaphy, lateral canthoplasty, upper and lower eyelid retractor release, and one- to three-wall orbital decompression.