Optic Nerve Involvement Associated with Thyroid Dysfunction

Abstract

TEN PATIENTS WITH OPTIC NERVE INVOLVEMENT associated with thyroid dysfunction are reported in this study. This is the largest group reported from any one institution. Such optic nerve disease is relatively uncommon and most reports in the literature are limited to one or two cases. However, two series of six patients' 2 and one of four3 have been published in sufficient detail within recent years to be of value for comparison. Each patient had orbital changes characteristic of those associated with Graves' disease. These consisted of tearing and irritation of the eyes, as well as upper lid retraction, deep injection at the outer aspects of the globes, lid swelling, chemosis, and extraocular muscle involvement. All these signs were not present in every patient, but the clinical picture in each case suggested the correct diagnosis. Only one patient showed any corneal irregularity, and this was slight. The fundi were examined with dilated pupils to eliminate other causes for the visual disturbances. In each instance the ocular tension was normal. Papilledema or papillitis offered little difficulty in diagnosis, but retrobulbar optic nerve involvement was diagnosed only in the presence of consistent visual field defects. CASE REPORTS CASE 1 A 59-year-old white male who was treated for byperthyroidism with R.A.I. in December, 1957. One year later his lids became puffy, the eyes felt sandy, and he had double vision on upward gaze. When first seen on April 7, 1959, the lids were full, the lacrimal glands palpable, the upper lids retracted, both globes showed deep injection temporally and there was marked limitation of elevation as well as of lateral movement.

Therapeutic Outcome of Prednisone Medication and of Orbital Irradiation in Patients with Graves’ Ophthalmopathy

“…1). Whereas others have observed improvement in class 6 upon prednisone treatment [6,7], visual acu ity did not change in our patients. This might be related to the fact that we were inclined to opt for orbital decompression in patients with threatened vision (i.e.…”

“…2). This is in agreement with most reports from the litera ture, although some authors describe prefer ential improvement of the soft-tissue in volvement and little or no improvement of proptosis and eye muscle involvement [2,[6][7][8][9], This has not been our experience since the decrease within the classes 2-4 upon treat ment was roughly similar ( fig. 1).…”

Late Onset Dysthyroid Optic Neuropathy

“…Optic neuropathy secondary to TAO is a vision-threatening condition estimated to affect between 5 and 8.6% of Graves' disease patients, usually those of older age (4)(5)(6). The optic neuropathy appears usually within the first 3 to 6 months of the ophthalmopathy (3,7).…”

Reversal of dysthyroid optic neuropathy following orbital fat decompression

“…It has often been noted that marked proptosis is often absent in patients with optic neuropathy 427Furthermore, the degree of proptosis may not correlate with the severity of neuropathy1 5 or the risk of development of neuropathy 28. It may therefore be argued that it is orbital pressure and not proptosis that correlates with optic neuropathy.…”