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Clinical features of dysthyroid optic neuropathy: a European Group on Graves’ Orbitopathy (EUGOGO) survey
  1. David McKeag1,
  2. Carol Lane1,
  3. John H Lazarus1,
  4. Lelio Baldeschi2,
  5. Kostas Boboridis3,
  6. A Jane Dickinson4,
  7. A Iain Hullo5,
  8. George Kahaly6,
  9. Gerry Krassas3,
  10. Claudio Marcocci7,
  11. Michele Marinò7,
  12. Maarten P Mourits2,
  13. Marco Nardi8,
  14. Christopher Neoh4,
  15. Jacques Orgiazzi5,
  16. Petros Perros4,
  17. Aldo Pinchera7,
  18. Susanne Pitz6,
  19. Mark F Prummel2,*,
  20. Maria S Sartini8,
  21. Wilmar M Wiersinga2
  1. 1University Hospital of Wales, Cardiff, United Kingdom
  2. 2Academic Medical Centre, University of Amsterdam, The Netherlands
  3. 3Panagia Central Hospital, Thessaloniki, Greece
  4. 4The Newcastle-upon- Tyne Hospitals NHS Trusts, Newcastle-upon- Tyne, United Kingdom
  5. 5Centre Hospitalier, Lyon-Sud, France
  6. 6Johannes Gutenberg Klinikum, University of Mainz, Germany
  7. 7Department of Endocrinology and Metabolism, University of Pisa, Italy
  8. 8Department of Neuroscience, University of Pisa, Italy
  1. Correspondence to: Prof J H Lazarus Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff CF 4 4XN, UK; Lazarus{at}


Background: This study was performed to determine clinical features of dysthyroid optic neuropathy (DON) across Europe.

Methods: Forty seven patients with DON presented to seven European centres during one year. Local protocols for thyroid status, ophthalmic examination and further investigation were used. Each eye was classified as having definite, equivocal, or no DON.

Results: Graves’ hyperthyroidism occurred in the majority; 20% had received radioiodine. Of 94 eyes, 55 had definite and 17 equivocal DON. Median Clinical Activity Score was 4/7 but 25% scored 3 or less, indicating severe inflammation was not essential. Best corrected visual acuity was 6/9 (Snellen) or worse in 75% of DON eyes. Colour vision was reduced in 33 eyes, of which all but one had DON. Half of the DON eyes had normal optic disc appearance. In DON eyes proptosis was > 21 mm (significant) in 66% and visual fields abnormal in 71%. Orbital imaging showed apical muscle crowding in 88% of DON patients. Optic nerve stretch and fat prolapse were infrequently reported.

Conclusion: Patients with DON may not have severe proptosis and orbital inflammation. Optic disc swelling, impaired colour vision and radiological evidence of apical optic nerve compression are the most useful clinical features in this series.

  • BCVA, best corrected visual acuity
  • CAS, clinical activity score
  • DON, dysthyroid optic neuropathy
  • EUGOGO, European Group on Graves’ orbitopathy
  • GO, Graves’ orbitopathy
  • MRI, magnetic resonance imaging
  • RAPD, relative afferent pupillary defect
  • VEP, visual evoked potential

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  • * Deceased

  • Published Online First 31 October 2006

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