I) Prevalence of TAO
II) Components of TAO
Active inflammation verses Passive Congestion
III) Thyroid Orbitopathy: Ophthalmic Clinical Workup
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Complete history with prior treatment
Comprehensive ocular health assessment
Evaluation for eyelid and soft tissue inflammation
Positional IOP fluctuation
Color vision testing
Exophthalmometry
ONH evaluation
Axial and coronal MRI
Saccadic velocity
Pattern visual evoked potentials
IV) Staging the Disease (Rundle’s Curve)
A.
B.
C.
D.
Phase of intense activity
Plateau phase
Spontaneous regression
Post-inflammatory (refractory stage)
V) Tx for Hyperthyroidism
A. RadioIodine I131
B. Surgical thyroidectomy
C. Anti-thyroid medication
Controversies and Considerations
VI) Does the Use of RadioIodine I131 Cause a Permanent Worsening of the
Orbitopathy?
A. The role of steroid anti-inflammatory treatment systemic hyperthyroidism
B. Avoid excessively low thyroid hormone levels during RadioIodine I131 treatment
VII) The Role of Orbital Radiation. Is it Safe? Is it Effective?
A. Mainstay treatment of TAO for five decades
B. Review of radiotherapy for TAO:
1) Columbia University experience
2) Mayo Clinic experience
3) The Dutch experience
VIII)
Anti-inflammatory Therapy in TAO
A. Oral verses IV steroids
B. Focal triamcinolone injections
C. Investigative Treatments
IX) Paradigm Shift in Orbital Decompression Surgery
A.
B.
C.
D.
Staging of surgical intervention
Intraconal fat removal
Initial superficial and deep lateral wall removal
Endoscopic orbital decompression
X) Conclusions
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