Abstract

Background: Thyroid eye disease (TED) is a debilitating autoimmune orbital disease that is often a result of Graves' disease. Dysthyroid optic neuropathy (DON) is a rare but sight-threatening manifestation of TED with therapeutic challenges that can potentially lead to visual loss. Purpose: To report the therapeutic challenges of a case of bilateral Dysthyroid optic neuropathy. Results: A 68-year-old smoker experienced active TED with extremely severe redness and swelling of the conjunctiva, loss of visual acuity and exacerbation of disfiguring proptosis. Computed tomography revealed the involvement of extraocular muscles resulting in optic nerve compression. He was in poor general condition and there was poor response to steroids. The patient responded well after orbital decompression, with improvements in clinical activity score and visual acuity. Conclusion: This case demonstrates a rare and severe case of bilateral DON with emphasis on timely and appropriate management.