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Dysthyroid eye disease masquerading as glaucoma.

Z I Currie1, S Lewis, L G Clearkin

  • 1Department of Ophthalmology, Barnsley District General Hospital, UK.

Ophthalmic & Physiological Optics : the Journal of the British College of Ophthalmic Opticians (Optometrists)
|April 1, 1991
PubMed
Summary

Raised intraocular pressure (IOP) may not indicate glaucoma. Dysthyroid eye disease can mimic glaucoma, leading to misdiagnosis. Optometrists should consider other causes when IOP is elevated without optic nerve damage.

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Area of Science:

  • Ophthalmology
  • Endocrinology

Background:

  • Intraocular pressure (IOP) screening is common in optometry.
  • Elevated IOP often suggests glaucoma, but other conditions can cause this finding.

Observation:

  • Four cases presented where patients were initially diagnosed with glaucoma due to raised IOP.
  • Further examination revealed no optic nerve or visual field abnormalities, prompting re-evaluation.
  • Dysthyroid eye disease was identified as the cause of elevated IOP in these patients.

Findings:

  • Dysthyroid eye disease can elevate IOP, particularly during upgaze, due to inferior rectus muscle thickening.
  • Inaccurate tonometry during upgaze (due to positioning or Bell's phenomenon) can lead to misleadingly high IOP readings.
  • Dysthyroid eye disease may present without a history of thyrotoxicosis or abnormal biochemical tests.

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Implications:

  • Optometrists must consider dysthyroid eye disease in patients with elevated IOP, especially if glaucoma signs are absent.
  • Key clinical signs of dysthyroid eye disease include lid lag, lid retraction, proptosis, and IOP elevation on upgaze.
  • Tonometry should be performed in the primary gaze position to avoid misinterpreting IOP measurements.