Non-surgical orbital decompression using diuresis in dysthyroid optic neuropathy: a case report

Abstract

Introduction: Dysthyroid optic neuropathy (DON) is a rare, severe form of thyroid eye disease, in which decreased visual acuity is accompanied by cha racteristic MRI findings. The treatment of DON has always been a challenge. Case presentation: In a patient in whom visual acuity deteriorated on the left eye, mannitol 20% 200 mL followed by furosemide 40 mg 6 h later, administered daily, were initiated on the day of admission. Visual function by ophthalmo logy methods, and orbital compartment volumes and water content by MRI were follo wed. Intravenous diuretics resulted in an immediate therapeutic response. Visual acuity improved from 20/50 to 20/25 after 2 days of treatment. MRI revealed dec reasing water content of both the muscle and connective tissue compartments without any volume changes. Subsequently, corticosteroids and orbital irradiation were started. Orbital decompression surgery was not required. Discussion/conclusion: Edematous swelling of orbital tissues is an established contributor of local pressure increase in thyroid eye disease. Diuretics re duce orbital pressure and, if confirmed by others, may be useful additions to the stan dard of care in sight-threatening DON.

Keywords

• thyroid eye disease
• dysthyroid optic neuropathy
• diuretics
• mri