Diagnosis and treatment of thyroid myopathy

Twenty-five patients with thyroid myopathy were referred to our Strabismus Clinic for treatment of diplopia. Prism treatment was effective in only three. When the remaining 22 patients' ocular motility problems and thyroid states were stable, surgical management was undertaken. The preoperative evaluation included visual fields, iris angiograms, binocular diplopia fields, intraocular pressures in different positions of gaze and A-scan echography. The goal of surgery was to produce as large a binocular visual field from primary as possible. Supramaximal recessions of the involved muscles were often needed and adjustable sutures were an important part of the surgical management. The complications encountered included limitation of movement into the field of the recessed muscle, inducement of an A-pattern in downgaze, and postoperative instability.