Sight-Threatening Condition in Severe Thyroid Eye Disease: How We Should Manage

Authors

  • Yunia Irawati Plastic and Reconstructive Surgery Division, Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
  • Dewi Megasari Juhrie Orbital and Oculoplastic Service, JEC Eye Hospitals and Clinics, Jakarta, Indonesia
  • Carennia Paramita Plastic and Reconstructive Surgery Division, Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
  • Darmayanti Siswoyo Orbital and Oculoplastic Service, JEC Eye Hospitals and Clinics, Jakarta, Indonesia
  • Hernawita Suharko Orbital and Oculoplastic Service, JEC Eye Hospitals and Clinics, Jakarta, Indonesia
  • Laurentius Aswin Pramono 1. Internal Medicine Service, JEC Eye Hospitals and Clinics, Jakarta, Indonesia. 2. Department of Public Health and Nutrition, School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.

Keywords:

grave’s disease, thyroid eye disease, dysthyroid optic neuropathy, orbital decompression, fat decompression

Abstract

Thyroid eye disease (TED) is an autoimmune disorder that is associated with thyroid gland dysfunction which causes muscle and orbital fat enlargement. This case report is aimed to present a case of sight-threatening TED and how we should manage this condition. We present a case of patient with chief complaint of vision loss and prominent eyes for 5 months prior to the visit to our eye hospital. Patient had sought advice from an ophthalmologist and internist. TED was eventually diagnosed 2 months after consulted with an ophthalmologist in the rural area. According to EUGOGO guidelines, TED with sight-threatening condition should be treated with glucocorticoid IV 500-1000 mg for 3 days consecutively. Although the patient was already given steroid injection for the initial treatment, the dosage was inadequate. After the inflammation process was reduced, the patient was reluctant to have an orbital decompression that was suggested. Hence, TED progressed continuously besides sight-threatening complications arising. He indeed underwent fat decompression and tarsorrhaphy as eyelid surgery to prevent corneal exposure. In follow-up, both visual acuity and corneal improvement were finally achieved. In the management of TED, collaboration between ophthalmologist and internist, who may be specialized in endocrinology, is imperative. They should be able to manage TED promptly and correctly, hence sight-threatening and other complications can be prevented and satisfactory results are achieved. Fat decompression should be considered as a good help to improve visual acuity nevertheless orbital decompression cannot be done.

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Published

2022-04-08

How to Cite

Irawati, Y., Juhrie, D. M., Paramita, C., Siswoyo, D., Suharko, H., & Pramono, L. A. (2022). Sight-Threatening Condition in Severe Thyroid Eye Disease: How We Should Manage. Acta Medica Indonesiana, 54(1), 124. Retrieved from https://actamedindones.org/index.php/ijim/article/view/1214

Issue

Vol. 54 No. 1 (2022): Acta Medica Indonesiana

Section

CASE REPORT

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