Table 3.3.10.1
Methods to assess the severity of Graves’ ophthalmopathy
NO SPECS class Item Method

1

Lid aperture

Maximum lid fissure in millimetres, using a ruler

2

Lid swelling

Subjective grading; photographs

3

Proptosis

In millimetres using a Hertel exophthalmometer

4

Motility

Range of motion in various directions of gaze

Goldmann or modified hand perimeter

Diplopia

Subjective grading as follows:

No diplopia

Intermittent diplopia (at awakening or when tired)

Inconstant diplopia (only at extremes of gaze)

Constant diplopia (in primary gaze or reading position)

Hess or Lancaster red–green screens

Field of single binocular vision

5

Cornea

Assessment of keratitis with rose Bengal or fluorescein

6

Optic nerve

Visual acuity

Visual fields

Colour vision

Pupillary function

Fundoscopy

NO SPECS class Item Method

1

Lid aperture

Maximum lid fissure in millimetres, using a ruler

2

Lid swelling

Subjective grading; photographs

3

Proptosis

In millimetres using a Hertel exophthalmometer

4

Motility

Range of motion in various directions of gaze

Goldmann or modified hand perimeter

Diplopia

Subjective grading as follows:

No diplopia

Intermittent diplopia (at awakening or when tired)

Inconstant diplopia (only at extremes of gaze)

Constant diplopia (in primary gaze or reading position)

Hess or Lancaster red–green screens

Field of single binocular vision

5

Cornea

Assessment of keratitis with rose Bengal or fluorescein

6

Optic nerve

Visual acuity

Visual fields

Colour vision

Pupillary function

Fundoscopy

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