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Speaker: Maintain high suspicion for compressive optic neuropathy in thyroid eye disease
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KOLOA, Hawaii — Compressive optic neuropathy is a finding of concern in patients with thyroid eye disease.
Speaking during the Oculoplastics symposium of the Hawaiian Eye 2017 meeting here, Eli L. Chang, MD, told colleagues, “The one key point that people fail to remember about thyroid eye disease is that it is potentially blinding.”
Eli L. Chang
Chang said that he has a “game plan” for addressing thyroid eye disease, with the first step being to make a diagnosis. Typically, thyroid eye disease is a conglomeration of adnexal and orbital findings associated with thyroid disease, which is typically self-limited, and has an initial inflammatory course followed by a nonprogressive phase that rarely recurs, according to Chang.
However, Chang said, “Approximately 4% to 6% of patients with thyroid eye disease will develop compressive optic neuropathy. That’s one in 20. That’s a real enough number to get yourself in trouble and get the patient in trouble if you’re not paying attention. ... It requires a high index of suspicion.”
Detecting vision threatening thyroid eye disease is a diagnosis made using visual fields and color vision testing, although visual evoked potentials yields the best information, he said.
Treating compressive optic neuropathy is best done with orbital decompression, according to Chang. Steroids are a temporary treatment, and radiation is useful for severe inflammation, he said.
“Ultimately, I think you’re going to end up with decompression surgery,” Chang said. “It really is the gold standard for treatment of compressive optic neuropathy.” – by Patricia Nale, ELS
Reference:
Chang EL. Thyroid eye disease. Presented at: Hawaiian Eye; Jan. 14-20, 2017; Koloa, Hawaii.
Disclosure: Chang reports no relevant financial disclosures.