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Dysthyroid optic neuropathy: a case series at a tertiary ophthalmic referral centre

Eye volume 38, pages 1168–1172 (2024)Cite this article

Subjects

Abstract

Background/Objectives

To determine risk factors and treatment outcomes in dysthyroid optic neuropathy (DON) at a single tertiary ophthalmic centre.

Methods

Retrospective audit of DON patients who have received intravenous methylprednisolone (IVMP) therapy at Royal Victorian Eye and Ear Hospital, Melbourne, Australia from July 2015 to October 2021.

Results

Study included 24 patients (58% female) with an average age of 59.8 ± 14.7 years at DON diagnosis. Majority (92%) had Graves’ hyperthyroidism and 77% had a smoking history. At diagnosis, average visual acuity (VA) of worse eye was LogMAR 0.46, and 48% had relative afferent pupillary defect. Proptosis (89%) and diplopia (73%) were most commonly present at diagnosis. 78% showed predominantly extra-ocular muscle enlargement, and apical crowding (52%) on radiology. 38% (n = 9/24) responded to IVMP alone, 58% (n = 14/24) progressed to surgical orbital decompression. The average total cumulative dose of IVMP during DON treatment was 6.8 ± 1.9 g. 29% required further treatment after IVMP and surgical decompression, 4 (17%) had additional radiotherapy, and three (13%) required immuno-modulatory therapy. Average final VA was LogMAR 0.207, with all patients having inactive TED at final follow-up (mean 1.7 years). In refractory DON cases, 71% retained VA ≥ 6/9 and 48% had DON reversal.

Conclusions

DON patients typically present in late 50s, with a smoking history and predominant extra-ocular muscle enlargement. High-dose IVMP fully resolved DON in only 38%. A considerable proportion required urgent orbital decompression. Most patients retained good vision at final follow-up.

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Fig. 1: Treatment modalities used for DON management amongst 24 DON patients.
Fig. 2: Comparison of the initial and final visual acuity of 24 patients during DON treatment over the average follow-up duration of 1.7 years.

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Data availability

The data that support the findings of this study are available from the Royal Victorian Eye and Ear Hospital but restrictions apply to the availability of these data. These data were utilised under a specific license for the current study and are not publicly accessible. Data are however available from the authors upon reasonable request and with permission of the Royal Victorian Eye and Ear Hospital.

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Authors and Affiliations

  1. Department of Ophthalmology, Austin Hospital, Heidelberg, VIC, Australia

    In Young Chung & Jwu Jin Khong

  2. Orbital, Plastic and Lacrimal Unit. The Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia

    Thomas G. Hardy & Jwu Jin Khong

  3. Centre for Eye Research Australia, Department of Surgery, University of Melbourne, East Melbourne, VIC, Australia

    Thomas G. Hardy & Jwu Jin Khong

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  1. In Young Chung
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Contributions

IC was responsible for designing the protocol, writing the manuscript, conducting the search, extracting and analysing data, interpreting results, updating reference lists, and creating tables and figures. JJK was responsible for conceiving the project, designing the protocol, and providing feedback on the report. TH was responsible for reviewing the article and providing feedback on the report.

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Correspondence to In Young Chung.

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Chung, I.Y., Hardy, T.G. & Khong, J.J. Dysthyroid optic neuropathy: a case series at a tertiary ophthalmic referral centre. Eye 38, 1168–1172 (2024). https://doi.org/10.1038/s41433-023-02856-7

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