Traumatic optic neuropathy complicated by thyroid eye disease

Thyroid eye disease is the most common orbital disorder found in adults. Ocular changes may occur with or without systemic hyperthyroidism. Blunt orbital trauma can affect the eye in many ways and can confound and alter the natural course of thyroid eye disease.

A 76-year-old patient with a number of ophthalmic findings and associated symptoms which could have been related to previous blunt ocular trauma. Careful optometric evaluation, systemic laboratory testing, and review of the ocular and medical findings demonstrated the onset of thyroid dysfunction.

Thyroid disease was diagnosed on the basis of the presence of enlarged extraocular muscles by CT scan and elevated tensions on attempted upgaze. The patient demonstrated an elevated T3 uptake and low TSH levels for which he was treated with propylthiouracil. The occurrence of thyroid disease and damage from blunt trauma confounded the diagnosis because forced duction testing and optic atrophy could well have been the result of previous blunt trauma.

This case elucidates the many differential diagnoses and complications that result from the combination of previous blunt trauma and the occurrence of new thyroid disease with ophthalmic findings.