Review Article
Graves’ Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management
Table 1
NO SPECS modified classification [
22].
| Class | Grade | Suggestions for grading |
| 0 | | No physical signs or symptoms |
| I | | Only signs |
| II | | Soft tissue involvement | 0 | Absent | a | Minimal | b | Moderate | c | Marked |
| III | | Proptosis (3 mm or more of normal upper limits with or without symptoms) | 0 | Absent | a | 3 or 4 mm over upper normal | b | 5 to 7 mm increase | c | 8 mm increase |
| IV | | Extraocular muscle involvement (usually with diplopia) | 0 | Absent | a | Limitation of motion at extremes of gaze | b | Evident restriction of motion | c | Fixation of a globe or globes |
| V | | Corneal involvement (primarily due to lagophthalmos) | 0 | Absent | a | Stippling of cornea | b | Ulceration | c | Clouding, necrosis, and perforation |
| VI | | Sight loss (due to optic nerve involvement) | 0 | Absent | a | Disc pallor or choking, or visual field defect, vision 20/20–20/60 | b | The same, but vision 20/70–20/200 | c | Blidness, vision less than 20/200 |
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