A patient was diagnosed with thyroid eye disease (TED) 2 years before presenting to our clinic. He complained of horizontal and vertical diplopia. The diplopia was constant and affected distance vision only. The patient was previously treated with teprotumumab. His exam was notable for esotropia which was worse in left gaze, while hypotropia of the left eye was worse in right gaze and upgaze, accompanied by limited elevation OS in adduction and incyclotorsion of the left eye, as well as restriction of extraocular movement of both eyes. The findings were most consistent with Brown syndrome of the left eye. He underwent surgical treatment consisting of a left superior oblique tendon expander and bilateral medial rectus muscle recession (3mm right, 6mm left) with orthotropia and resolution of the diplopia postoperatively.
Presentation Date: 12/15/2022
Issue Date: 01/06/2023