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Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.

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Endotext [Internet].

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Class

Grade

Symptoms and Signs

0

No symptoms or signs

1

Only signs (upper lid retraction, without lid lag or proptosis)

2

Soft tissue involvement with symptoms (excess lacrimation, sandy sensation, retrobulbar discomfort, and photophobia, but not diplopia);objective signs as follows:

0

absent

a

minimal (edema of conjunctivae and lids, conjunctival injection, and fullness of lids, often with orbital fat extrusion, palpable lacrimal glands, or swollen extraocular muscles beneath lower lids)

b

Moderate (above plus chemosis, lagophthalmos lid fullness)

c

marked

3

Proptosis associated with classes 2 to 6 only (specify if inequality of 3 mm or more between eyes, or if progression of 3 mm or more under observation)

0

absent (20 mm or less)

a

minimal (21-23 mm)

b

moderate (24-27 mm)

c

marked (28 mm or more)

4

Extraocular muscle involvement (usually with diplopia)

0

absent

a

minimal (limitation of motion, evident at extremes of gaze in one or more directions)

b

moderate (evident restriction of motion without fixation of position)

c

marked (fixation of position of a globe or globes)

5

Corneal involvement (primarily due to lagophthalmos)

0

absent

a

minimal (stippling of cornea)

b

moderate (ulceration)

c

marked (clouding, necrosis, perforation)

6

Sight loss (due to optic nerve involvement)

0

absent

a

minimal (disc pallor or choking, or visual field defect, vision 20/20 to 20/60)

b

moderate (disc pallor or choking, or visual field defect, vision 20/70 to 20/200)

c

marked (blindness, i.e., failure to perceive light; vision less than 20/200)

From Werner (93).

From: Graves’ Disease: Complications

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