Traumatic optic neuropathy complicated by thyroid eye disease

Area of Science:

• Ophthalmology
• Endocrinology
• Orbital Disorders

Background:

• Thyroid eye disease is a common orbital disorder in adults, potentially occurring with or without hyperthyroidism.
• Blunt orbital trauma can significantly impact ocular structures and alter the presentation of thyroid eye disease.

Observation:

• A 76-year-old patient presented with ophthalmic findings potentially linked to prior blunt ocular trauma.
• Systemic laboratory testing and optometric evaluation revealed the onset of thyroid dysfunction.

Findings:

• Diagnosis of thyroid disease was supported by CT-identified enlarged extraocular muscles and elevated intraocular pressure during upgaze.
• Elevated T3 uptake and low TSH levels indicated hyperthyroidism, treated with propylthiouracil.
• Differentiating between trauma-induced damage and thyroid disease was challenging due to overlapping signs like forced duction testing abnormalities and optic atrophy.

Implications:

• This case underscores the complex differential diagnoses and potential complications arising from the interplay of blunt trauma and new-onset thyroid disease.
• Accurate diagnosis requires careful consideration of both etiological factors to manage ophthalmic findings effectively.