Abstract ID: 26-146
Thyroid eye disease: case report, the challenges of surgical treatment
Author: Lilit Arustamyan Base Hospital / Institution: S.V. Malayan eye centre
Presentation Type: ePoster Presentation
Purpose
To present a case of thyroid eye disease and highlight the challenges facing during surgical treatment.
Methods
A 48 years-old man, who was a heavy smoker, was complaining about left eye pain, eyelid swelling, which was present for more than 6 months. During examination the visual acuity was 20/70 with correction sph(+)1.5D 20/25 for right eye,2/20 with correction sph(+)1.5D 20/100 for left eye.He had eyelid retraction for both eyes,5 mm proptosis from left eye. There was oval ulcer on cornea,exposure keratopathy, esotropia 5 degree. During ophthalmoscopy optic nerves were vertical ,5/10 cupping from right eye ,7.5/10 cupping from left eye. He was prescribed antiglaucoma eyedrop. The diagnosis was Graves disease, thyroid eye disease, left eye proptosis,lagophthalmos, eyelid retraction, esotropia, secondary glaucoma, corneal ulcer, exposure keratopathy. For the 1st step medial tarsorrhaphy was performed to treat corneal ulcer. After 1 month cadaver scleral transplantation was performed to elongate posterior lamella of the eyelid. During follow-up, left eye dysthyroid optic neuropathy was diagnosed, patient’s visual acuity was decreased up to finger counting. The decision was made to do left eye medial and inferior orbitotomy.
During operation, as orbital adipose tissue was so inflammated and fibrosed because of nicotine use for many years, eyeball was repositioned only for 2 mm.
7th day post-op eyelid edema was present, esotropia was 30 degree. 3 months post-op left eye visual acuity was 2/50 with correction 2/25. 5 months post-op visual acuity was increased up to 2/50 with correction 2/20, there was 3 mm proptosis of the left eye.
Results
Even with smoking anamnesis, severe dysthyroid optic neuropathy, patient had increased visual acuity and compensation of secondary glaucoma after orbital decompression.
Conclusion
Thyroid eye disease is an autoimmune disorder of the orbit. In the clinical case, significant improvement of dysthyroid optic neuropathy and increased visual acuity were observed 5 months after the surgery. The outcome was particularly unexpected, considering that the patient was heavy smoker.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Armine | Gharakeshishyan | S.V. Malayan eye centre |