**6.4 Treatment of Graves' orbitopathy in patients with Graves' Disease**

The optimal treatment of GO require restoration of euthyroidism and management of orbitopathy. Smoking should be discouraged as smoking increases progression and severity of GO and worsens the outcome [60]. Management of orbitopathy depends on its severity and activity. Mild inactive disease can be managed conservatively by artificial tear films only. In severe and active disease intravenous pulse steroid therapy may be required to decrease inflammation. External beam radiotherapy has also been used in severe cases. In patient with sight threatening and dysthyroid optic neuropathy (DON) orbital decompressive surgery is the only option proven to be effective. Rituximab, a anti CD20+ monoclonal antibody that causes B Cell depletion shown to be very effective in decreasing severity and activity od orbitopathy [61].
