Postural visual obscurations in patients with inactive thyroid eye disease; a variant of 'hydraulic' disease
Abstract
AIM: This investigation newly describes the characteristics and treatment for a group of patients with inactive thyroid eye disease who presented with recurrent transient visual obscuration, generally related to sudden changes in posture.
STUDY DESIGN: A retrospective case-note review of an unmatched case series.
PATIENTS AND METHODS: Clinical records were reviewed for patients with thyroid eye disease, presenting to the Orbital Clinic at Moorfields Eye Hospital with recurrent transient visual obscuration. All patients underwent orbital decompression and the response to this, and other, treatment was reviewed.
RESULTS: Six patients (five female) presented to the Orbital Clinic, between the ages of 43 and 66 years (mean 54.7; median 52 years), with recurrent visual obscurations related to postural changes. Transient obscurations had been noted for between 3 weeks and 2 months, the patients having had symptoms of underlying thyroid eye disease for between 6 and 18 months. Five patients had diabetes for between 2 and 45 years, four being controlled with insulin and one with metformin. All patients had increased orbital tension on clinical assessment, intraocular pressures were raised in 5/6, and the optic disc in affected eyes was markedly swollen (with bilateral choroidal folds in two patients). Hertel exophthalmometry ranged from 22 to 27 mm, and there was a global reduction in ocular ductions in all. Bilateral orbital decompression was performed in all patients, although…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 6 participants or records.
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