Dysthyroid optic neuropathy. Clinical profile and rationale for management
J. D. Trobe, J. S. Glaser and P. Laflamme
Dysthyroid optic neuropathy (DON) was diagnosed in 36 eyes of 21 patients
with progressive visual loss and congestive ophthalmopathy. Systemic
features in the patients with DON did not differ from those reported for
Graves' disease patients except that patients with DON were older (mean
age, 61 years) and did not show female preponderance. Congestive symptoms
always preceded visual loss, which was gradual in onset and bilateral in
most patients but acute and asymmetrical in several. Presenting acuities
were poorer than 20/60 in 50% of cases; central scotomas, sometimes
combined with inferior depression, were the predominant field defects.
Congestive signs were of moderate intensity without severe proptosis or
exposure keratopathy. Bilateral and symmetrical ductional restriction was
the most common motility disturbance. Oral corticosteroids were effective
in restoring visual function in ten of 21 eyes treated. Many
steroid-unresponsive eyes were improved promptly by supervoltage orbital
irradiation or surgical decompression. In general, therapeutic intervention
appeared to hasten recovery and improve visual outcome.
