A 57-year-old woman with PMH of hyperthyroidism presents with eye pain, swelling, and blurry vision worsening for 3 weeks. Exam revealed severe proptosis, exposure keratopathy, orbital congestion, and markedly reduced visual acuity. CT and laboratory were workup consistent with sight-threatening thyroid eye disease. Typically, these cases are treated with prompt orbital decompression; however, this patient was not medically cleared for surgery. Temporizing measures, including corticosteroids, which are a mainstay of treatment in moderate to severe thyroid eye disease, also include local steroid injection, orbital radiotherapy, rituximab, and a variety of new biologic agents including anti IL6 and IGF-1 antibodies.
Presentation Date: 02/08/2018
Issue Date: 08/01/2020