NOSPECS Classification - Thyroid Ophthalmopathy

 Werner NOSPECS- Thyroid Ophthalmopathy

Source: DJO

American Thyroid Association (ATA) has classified Graves’ ophthalmopathy, irrespective of the hormonal status into following classes, characterised by the acronym ‘NOSPECS’.

Class 0 N: No signs and symptoms.

Class 1 O: Only signs, no symptoms (signs are limited to lid retraction, with or without lid lag and mild proptosis).

Class 2 S: Soft tissue involvement with signs (as described in Class-1) and symptoms including lacrimation, photophobia, lid or conjunctival swelling.

Class 3 P: Proptosis is well established.

Class 4 E: Extraocular muscle involvement 

(limitation of movement and diplopia).

Class 5 C: Corneal involvement

(exposure keratitis).

Class 6 S: Sight loss due to optic nerve involvement with disc pallor or papilloedema and visual field defects.

• For practical purposes it has been described as: 

1. ‘Early’ (which include ATA Class 1 & 2) and 

2. ‘Late Graves’ ophthalmopathy’ (Class 3 to 6).

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