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Assessment of Graves' orbitopathy: Clinical activity score elements[1,2]

Assessment of Graves' orbitopathy: Clinical activity score elements[1,2]
Elements* Each visit Comparison with previous visit Score
Painful feeling behind the globe over last four weeks X   1
Pain with eye movement during last four weeks X   1
Redness of the eyelids X   1
Redness of the conjunctiva X   1
Swelling of the eyelids X   1
Chemosis (edema of the conjunctiva) X   1
Swollen caruncle (flesh body at medial angle of eye) X   1
Increase in proptosis ≥2 mm   X 1
Decreased eye movements ≥5° any direction   X 1
Decreased visual acuity ≥1 line on Snellen chart   X 1
GO: Graves' orbitopathy; CAS: clinical activity score.
* A seven-point scale (excluding the last three elements) is used when no previous assessment is available. GO is considered active in patients with a CAS ≥3.
References:
  1. Mourits MP, Koornneef L, Wiersinga WM, et al. Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: A novel approach. Br J Ophthalmol 1989; 73:639.
  2. Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clin Endocrinol (Oxf) 1997; 47:9.
Reproduced with permission from: Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016; 26:1343. Copyright © 2016 Mary Ann Liebert, Inc. publishers.
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