Dysthyroid optic neuropathy: update on pathogenesis, diagnosis, and management

ABSTRACT

Introduction: Dysthyroid optic neuropathy (DON) is a severe manifestation of thyroid eye disease (TED) that can result in permanent vision loss. Management is complex, multidisciplinary, and involves medical and/or surgical therapies. This review describes current concepts in the epidemiology, pathophysiology, diagnosis, and treatment of DON.

Areas covered: An extensive review of the literature was performed to detail current concepts on the diagnosis and management of DON. This includes utilization of various medical and surgical modalities for disease management.

Expert commentary: DON can result in permanent blindness and often requires the use of corticosteroids and surgical decompression. We favor the use of intravenous corticosteroids and a transcaruncular approach when surgical decompression is indicated. The use of orbital radiation for DON is often reserved for patients that are poor surgical candidates and/or patients with refractory disease.

KEYWORDS:

• Graves’ ophthalmopathy
• thyroid eye disease
• dysthyroid optic neuropathy
• compressive optic neuropathy
• orbital apex syndrome
• orbital decompression
• orbital radiotherapy
• rituximab

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

The authors declare the following funding NIH-NEI P30 Core Grant- IP30EY025585-01A1; Unrestricted Grant from Research to Prevent Blindness.