Thyroid Eye Disease With Divergence Insufficiency Causing Recurrent Falls in an Elderly Patient

Area of Science:

• Ophthalmology
• Geriatrics
• Endocrinology

Background:

• Recurrent falls are a significant health concern in the elderly, affecting over one-third of individuals aged 65+ annually.
• Falls are multifactorial, often requiring extensive workups for conditions like postural hypotension, syncope, seizures, and cognitive impairment.
• Hyperthyroidism is a common endocrine disorder in the elderly, with thyroid ophthalmopathy being a potential complication.

Observation:

• An elderly woman experienced recurrent falls despite negative laboratory and imaging results during her workup.
• The patient was diagnosed with divergence insufficiency and intermittent esotropia, a condition linked to thyroid ophthalmopathy.
• This visual impairment caused horizontal diplopia, contributing to her falls, particularly noticeable at further distances.

Findings:

• Thyroid ophthalmopathy can manifest with subtle ocular motility issues, such as divergence insufficiency.
• Intermittent esotropia secondary to thyroid ophthalmopathy can lead to horizontal diplopia and unsteadiness, increasing fall risk.
• Standard diagnostic workups may miss ocular causes of falls in elderly patients.

Implications:

• A comprehensive visual examination should be a routine part of the fall workup in elderly patients, especially those with unexplained recurrent falls.
• Early identification of visual disturbances like diplopia can prevent unnecessary diagnostic procedures and guide appropriate treatment.
• Ophthalmological assessment, including evaluation for strabismus and motility disorders, is vital for managing falls in the geriatric population.