Thyroid-associated ophthalmopathy: a neuro-ophthalmologist’s perspective

Abstract

Thyroid-associated ophthalmopathy is an autoimmune process representing the commonest and most important extra-thyroidal manifestation of Graves’ disease. Ophthal- mologists are often the first doctors to see these patients. Due to a wide range of ocular features, patients with thyroid-associated ophthalmopathy may be seen by more than one ophthalmic sub-specialist. Neuro-ophthalmol- ogists are often involved in the management of patients with thyroid-associated ophthalmopathy since diplopia is one of its common and debilitating symptoms. Moreover, visual loss due to dysthyroid optic neuropathy is a poten- tially irreversible sight-threatening complication if treat- ment is delayed. This article focuses on the management of patients with thyroid-associated ophthalmopathy with diplopia or dysthyroid optic neuropathy, from a neuro- ophthalmologist’s perspective. Practical issues and pitfalls in the management of these patients are elucidated.