Abstract ID: 26-373
When Cataract Is Not the Only Diagnosis: Bilateral Exophthalmos Revealing Graves’ Orbitopathy in an Elderly Patient
Author: Asma ZAGHDOUDI Base Hospital / Institution: Tahar Sfar University Hospital Mahdia
Presentation Type: ePoster Presentation
Purpose
To report a case of previously undiagnosed Graves’ orbitopathy revealed during the assessment of progressive visual impairment initially attributed to cataract in an elderly patient.
Methods
A 70-year-old woman with no significant past medical history presented with progressive bilateral visual loss. Ophthalmological examination revealed moderately dense bilateral cataract associated with bilateral axial exophthalmos. No diplopia, exposure keratopathy, restrictive strabismus, or signs of compressive optic neuropathy were observed. Macular and optic nerve OCT findings were normal. Thyroid function tests and orbital MRI were performed.
Results
Laboratory investigations demonstrated a markedly suppressed thyroid-stimulating hormone level. Orbital MRI revealed grade II bilateral exophthalmos associated with enlargement of the extraocular muscles, consistent with thyroid-associated orbitopathy. The patient was referred for endocrinological management and multidisciplinary follow-up.
Conclusion
Graves’ orbitopathy is the most common inflammatory orbital disorder associated with autoimmune thyroid disease. Although it usually occurs in patients with known thyroid dysfunction, ophthalmic manifestations may occasionally precede systemic diagnosis. In elderly patients, visual impairment may be misleadingly attributed to age-related ocular conditions such as cataract. This case highlights the importance of careful orbital examination and orbital imaging in patients presenting with progressive visual loss. Early recognition of thyroid-associated orbitopathy allows timely multidisciplinary management and may prevent vision-threatening complications.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Saleh Eddine | Hamdi | Tahar Sfar University Hospital Mahdia |
| Sameh | Mbarek | Tahar Sfar University Hospital Mahdia |
| Nada | Sakli | Tahar Sfar University Hospital Mahdia |
| Afef | Chabbeh | Tahar Sfar University Hospital Mahdia |
| Wafa | Ammari | Tahar Sfar University Hospital Mahdia |
| Anis | Mahmoud | Tahar Sfar University Hospital Mahdia |
| Riadh | Massaoud | Tahar Sfar University Hospital Mahdia |