Plasma exchange in conjunction with immunosuppressive drug therapy in the treatment of endocrine exophthalmos.

We describe three patients who developed severe endocrine ophthalmopathy at 3, 12 and 18 months after treatment with iodine-131. In two cases with congestive ophthalmopathy steroids alone and plasma exchange alone failed to produce a satisfactory response, but the combination of plasma exchange with steroids or steroids plus cyclophosphamide was followed by resolution of papilloedema and return of visual acuity to normal as well as definite improvement in the other signs of ophthalmopathy. In the remaining case, which did not have papilloedema the signs of ophthalmopathy were progressive despite treatment with steroids. Combined treatment with plasma exchange, steroids and cyclophosphamide resulted in improvement in visual acuity and resolution of periorbital oedema and diplopia. Plasma exchange may be a useful adjunct to immunosuppressive therapy in the treatment of acute progressive endocrine exophthalmos.