Dysthyroid Orbitopathy and Scotoma (Kennerdell Case 57, PPT)

History: A 36-year-old woman was referred with thyroid disease and a recent onset of swelling of the lids, proptosis, and vision loss. Her visual acuity was 20/50 in the right eye and 20/25 in the left eye. Her Hertel measurements were 17 in both eyes with a base of 95. Her visual fields showed central scotoma worse on the right than the left eye and her optic discs were normal. Anatomy: Orbit; Entire medial rectus; Entire extraocular muscle; Eyelid. Clinical: Visual acuity was 20/50 in the right eye and 20/25 in the left eye. Hertel measurements were 17 in both eyes with a base of 95. Visual fields showed central scotoma worse on the right than the left eye. Disease Diagnosis: Thyroid Associated Ophthalmopathy; Dysthyroid Orbitopathy. Presenting Symptom: Thyroid disease and a recent onset of swelling of the lids, proptosis, and vision loss. Neuroimaging: A marked enlargement of the extraocular muscles and Dysthyroid Orbitopathy with compression of the Optic Nerves in the apex of the orbit, especially by the swollen medial rectus muscles. The coronal view of the apical compression of the Optic Nerve with the enlarged extraocular muscles. The patient one month following treatment with the radiation therapy with less swelling of the lids and improvement of the vision to 20/20 in each eye with normal color vision. The diminished size of the extraocular muscles, especially the medial recti following the radiation therapy. The patient was followed for four years and had no recurrence of the severe Dysthyroid Orbitopathy. Treatment: 2,000 cGy of radiation therapy.