The Ophthalmopathy Index of Bartalena et al is a numerical score for quantitation of the eye changes in Graves' disease. It is a modification of the Ophthalmopathy Index of Donaldson et al, which was felt to overestimate the importance of eyelid and conjunctival involvement and to underestimate factors affecting sight (optic neuropathy, corneal embarrassment, extraocular muscle involvement. The new index gives better assessment of treatment results.
Some differences from Ophthalmopathy Index of Donaldson:
(1) changes in scoring of exophthalmos, extraocular myopathy and optic nerve involvement
(2) addition of score for lagophthalmos
(3) addition of score for diplopia
|
Parameter |
Degree of Involvement |
Points |
|
soft tissue changes (periorbital edema, conjunctival injection, chemosis) |
slight |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
proptosis |
slight (19-20 mm) |
1 |
|
|
moderate (21-23 mm) |
2 |
|
|
severe (>= 24 mm) |
4 |
|
lagophthalmos (due to proptosis and/or lid retraction, as measured by palpebral width during unforced closure) |
slight (< 2 mm) |
1 |
|
|
moderate (2-5 mm) |
2 |
|
|
severe (> 5 mm) |
3 |
|
impairment of extraocular muscle movements (restriction of movements) |
slight deficit |
1 |
|
|
moderate deficit |
2 |
|
|
severe deficit |
4 |
|
diplopia |
intermittent |
1 |
|
|
inconstant |
2 |
|
|
constant |
4 |
|
corneal involvement |
initial lesions (fluorescein-positive) |
1 |
|
|
ulcers |
2 |
|
|
clouding, perforation, scar |
3 |
|
optic neuropathy |
no sight loss (but instrumental evidence) |
3 |
|
|
visual acuity 5/10-9/10 |
5 |
|
|
visual acuity 1/10-4/10 |
7 |
|
|
visual acuity < 1/10 |
9 |
where:
• Diplopia is intermittent (present only when patient is fatigued), inconstant (present only on lateral or upward gaze), or constant (present on straight and level gaze).
• Extraocular muscle movement evaluated by Hess chart, Lancaster red-green test or forced duction test.
• Optic neuropathy assessed by perimetry, visual acuity, color vision, evoked visual potentials, fundus examination and CT scan.
modified Ophthalmopathy Index =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score 0
• maximum score 30
• The higher the score, the greater the severity of the ophthalmopathy.
Specialty: Ophthalmology, Endocrinology
ICD-10: ,
