Dysthyroid Orbitopathy and Esotropia (Kennerdell Case 58, PPT)

History: A 44-year-old woman with known thyroid disease was referred with acute swelling of the orbital tissues and loss of vision. Her visual acuity was 20/50 in the right eye and 20/40 in the left eye. Presenting symptom: Acute swelling of the orbital tissues and loss of vision. Neuroimaging: The markedly enlarged inferior rectus with part of the compression and base in an axial view. Coronal view showing compression of the Optic Nerve in the apex of the orbit. Anatomy: Orbit; Orbital disc; Entire inferior rectus. Clinical: Visual acuity was 20/50 in the right eye and 20/40 in the left eye. Hertel measurements were 22 right and 20 left with a base of 102. Minimal proptosis. Disease Diagnosis: Thyroid Associated Ophthalmopathy; Dysthyroid Orbitopathy. Treatment: The patient was treated with steroids to which she became dependent, but the left eye recovered good vision, whereas the right eye maintained decreased vision as the result of the apical compression. Patient underwent right orbital decompression of the medial and inferior walls, resulting in esotropia. She later underwent a right medial rectus resection to straighten the right eye.