Graves’ Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management
Table 5
Proposed “GO activity assessment checklist” based on VISA and EUGOGO classifications. Any change in the progression symptoms or inflammatory score higher than 5 would warrant more aggressive therapy.
(a)
Inflammatory signs and symptoms
0
1
2
Diurnal variation (0)-(1)
Absent
(i) Inflammation worse with the head dependent after sleep or (ii) worsening of diplopia at morning
Retrobulbar ache at rest (0)-(1)
Absent
Present
Retrobulbar ache with gaze (0)-(1)
Absent
Present
Lid edema (score worst eyelid) (0)-(1)-(2)
(i) Absent or (ii) mild or (iii) not thought to be due to active GO
Present but without redundant tissues
Present and causing bulging in the palpebral skin (tense subcutaneous fluid): (i) upper lid fold remains rounded on downgaze or (ii) lower lid festoon
Lid redness (score worst eyelid) (0)-(1)
(i) Absent or (ii) not thought to be due to active GO
Present
Conjunctival redness (0)-(1)
(i) Absent or (ii) equivocal or (iii) mild or (iv) not thought to be due to active GO
Diffuse redness, covering at least one quadrant assessed without slit-lamp at 1 meter from the patient
Chemosis (0)-(1)-(2)
(i) Absent or (ii) conjunctivochalasis
Separation of conjunctiva from sclera present in >1/3 of the total height of the palpebral aperture Conjunctiva behind posterior to the grey line
Conjunctiva anterior to the grey line
Inflammation of caruncle OR plica (0)-(1)
Absent
(i) Plica is prolapsed through closed eyelids or (ii) caruncle and/or plica are inflamed
Total inflammatory score: /10
Score worst eye.
(b)
Progression symptoms (changes in the previous 1–3 months)
0
1
Optic Neuropathy (0)-(1)
Same or Better
Disc swelling or atrophy thought to be due to GO, or 2 of the following: (i) Decreased visual acuity equivalent to 1 Snellen line (ii) Afferent pupil defect (iii) Impaired colour perception
Extraocular muscle ductions (0)-(1)
Same or Better
Decrease in uniocular ocular excursion in any one direction of ≥12°
