—Dr Frueh is correct. Not only are "all the facts... not yet in," but those "facts" that are in are difficult to define, even in terms of reasonably scrutinizable data. Dr Frueh's patient is indeed fortunate to have had a reduction from 3 to 1 Δ of intermittent right hypertropia in primary gaze after more than eight months of high-dosage prednisone therapy that rendered her cushingoid, followed by irradiation therapy. Presumably, simple prismatic correction was not tolerated.There may well be other such cases or even more dramatic quantitative effects of orbital irradiation in gravesian ophthalmoplegia, but, until this elusive subset of treated patients surfaces for public inspection, we are compelled to exercise management protocols based on personal experience and the meager information available from published series. For example, Brennan et al1 concluded that "extraocular muscle restriction was least altered by radiation therapy," but there is no
Glaser JS. Graves' Ophthalmopathy-Reply. Arch Ophthalmol. 1985;103(8):1110–1112. doi:https://doi.org/10.1001/archopht.1985.01050080022006
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