Dysthyroid optic neuropathy: Demographics, risk factors, investigations, and management outcomes
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Date
2022-12
Journal Title
Journal ISSN
Volume Title
Publisher
All India Ophthalmological Society
Abstract
Purpose: To analyze the clinical presentations, risk factors, and management outcomes in patients presenting with dysthyroid optic neuropathy (DON). Methods: This is a retrospective, single?center study carried out on consecutive patients presenting with DON over a period of 4 years (2013–2016). The VISA classification was used at the first visit and subsequent follow?ups. The diagnosis was based on optic nerve function tests and imaging features. Demographic profiles, clinical features, risk factors, and management outcomes were analyzed. Results: Thirty?seven eyes of 26 patients diagnosed with DON were included in the study. A significant male preponderance was noted (20, 76.92%). Twenty patients (76.9%, P = 0.011) had hyperthyroidism, and 15 (57.69%, P = 0.02) were smokers. Decreased visual acuity was noted in 28 eyes (75.6%). Abnormal color vision and relative afferent pupillary defects were seen in 24 (64.86%) eyes, and visual field defects were seen in 30 (81.01%) eyes. The visual evoked potential (VEP) showed a reduced amplitude in 30 (96.77%, P = 0.001) of 31 eyes and delayed latency in 20 (64.51%, P = 0.0289) eyes. Twenty?six (70.27%) patients were treated with intravenous methyl prednisolone (IVMP) alone, whereas 11 (29.72%) needed surgical decompression. The overall best?corrected visual acuity improved by 0.2 l logMARunits. There was no statistically significant difference in outcome between medically and surgically treated groups. Four patients developed recurrent DON, and all of them were diabetics. Conclusion: Male gender, hyperthyroid state, and smoking are risk factors for developing DON. VEP, apical crowding, and optic nerve compression are sensitive indicators for diagnosing DON. Diabetics may have a more defiant course and are prone to develop recurrent DON.
Description
Keywords
Dysthyroid optic neuropathy, Thyroid orbitopathy, Visual evoked potential
Citation
Poonam Nisar Sonam, Alam Md. Shahid, Oberoi Prashant, Mukherjee Bipasha. Dysthyroid optic neuropathy: Demographics, risk factors, investigations, and management outcomes. Indian Journal of Ophthalmology. 2022 Dec; 70(12): 4419-4426