P05.01. Case Report: Dysconjugate Gaze in a Patient With Graves' Orbitopathy

Focus Area: Integrative Approaches to Care Moderate-to-severe Graves' orbitopathy (GO) at baseline is an uncommon finding with a new diagnosis of Graves' disease (GD). Patients with baseline GO usually have mild symptoms or are asymptomatic. The natural history and prevalence of GO are poorly documented. Current standard of care is to treat with IV methylprednisolone pulses. This is a case report of a 63-year-old woman with a 1-year diagnosis of moderate-to-severe GO. Six months prior to diagnosis, she developed progressively worsening blurry vision and eventually diplopia. She was treated with radioactive iodine therapy and achieved a euthyroid state; however, there was no improvement in her ocular symptoms. She was evaluated by the Graves' Orbitopathy clinic at Jules Stein Eye Institute at UCLA. It was determined that this patient would not benefit from steroid treatment due to the lack of any signs of active inflammation and with potential side effects, such as exacerbation of her poorly controlled hypertension and anxiety. A referral was made to the UCLA Center for East-West Medicine for an alternative approach to treatment. A literature search for moderate-to-severe GO using complementary/integrative medicine treatments proved to be limited. The initial exam revealed dysconjugate gaze with left eye looking inferiorly and laterally (mimicking a 3rd nerve palsy), spasm of the trapezius and splenius capitis muscles, and a startle reaction with palpation of most acupressure points. Acupuncture as well as trigger-point injections were administered, with marked improvement in eye position and dysconjugate gaze after one treatment. Improvement continued after 3 sessions, 1 week apart, including a reduction of her diplopia. The patient reported that she was now able to go up and down stairs without the need of a handrail and was able to walk over curbs without difficulty.