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

INTRODUCTION: Dysthyroid optic neuropathy (DON) is a rare, severe form of thyroid eye disease, in which decreased visual acuity is accompanied by characteristic MRI findings. The treatment of DON has always been a challenge. CASE PRESENTATION: In a patient in whom visual acuity deteriorated on the l...

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Autores principales: Erdei, Annamaria, Gazdag, Annamaria, Ujhelyi, Bernadett, Nagy, Edit B, Berenyi, Ervin, Berta, Eszter, Steiber, Zita, Barna, Sandor, Mezosi, Emese, Bodor, Miklos, Nagy, Endre V
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9422236/
https://www.ncbi.nlm.nih.gov/pubmed/35900798
http://dx.doi.org/10.1530/ETJ-22-0078
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author Erdei, Annamaria
Gazdag, Annamaria
Ujhelyi, Bernadett
Nagy, Edit B
Berenyi, Ervin
Berta, Eszter
Steiber, Zita
Barna, Sandor
Mezosi, Emese
Bodor, Miklos
Nagy, Endre V
author_facet Erdei, Annamaria
Gazdag, Annamaria
Ujhelyi, Bernadett
Nagy, Edit B
Berenyi, Ervin
Berta, Eszter
Steiber, Zita
Barna, Sandor
Mezosi, Emese
Bodor, Miklos
Nagy, Endre V
author_sort Erdei, Annamaria
collection PubMed
description INTRODUCTION: Dysthyroid optic neuropathy (DON) is a rare, severe form of thyroid eye disease, in which decreased visual acuity is accompanied by characteristic 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 ophthalmology methods, and orbital compartment volumes and water content by MRI were followed. Intravenous diuretics resulted in an immediate therapeutic response. Visual acuity improved from 20/50 to 20/25 after 2 days of treatment. MRI revealed decreasing 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 reduce orbital pressure and, if confirmed by others, may be useful additions to the standard of care in sight-threatening DON.
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spelling pubmed-94222362022-08-29 Non-surgical orbital decompression using diuresis in dysthyroid optic neuropathy: a case report Erdei, Annamaria Gazdag, Annamaria Ujhelyi, Bernadett Nagy, Edit B Berenyi, Ervin Berta, Eszter Steiber, Zita Barna, Sandor Mezosi, Emese Bodor, Miklos Nagy, Endre V Eur Thyroid J Case Report INTRODUCTION: Dysthyroid optic neuropathy (DON) is a rare, severe form of thyroid eye disease, in which decreased visual acuity is accompanied by characteristic 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 ophthalmology methods, and orbital compartment volumes and water content by MRI were followed. Intravenous diuretics resulted in an immediate therapeutic response. Visual acuity improved from 20/50 to 20/25 after 2 days of treatment. MRI revealed decreasing 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 reduce orbital pressure and, if confirmed by others, may be useful additions to the standard of care in sight-threatening DON. Bioscientifica Ltd 2022-07-03 /pmc/articles/PMC9422236/ /pubmed/35900798 http://dx.doi.org/10.1530/ETJ-22-0078 Text en © The authors https://creativecommons.org/licenses/by/4.0/This work is licensed under a Creative Commons Attribution 4.0 International License. (https://creativecommons.org/licenses/by/4.0/)
spellingShingle Case Report
Erdei, Annamaria
Gazdag, Annamaria
Ujhelyi, Bernadett
Nagy, Edit B
Berenyi, Ervin
Berta, Eszter
Steiber, Zita
Barna, Sandor
Mezosi, Emese
Bodor, Miklos
Nagy, Endre V
Non-surgical orbital decompression using diuresis in dysthyroid optic neuropathy: a case report
title Non-surgical orbital decompression using diuresis in dysthyroid optic neuropathy: a case report
title_full Non-surgical orbital decompression using diuresis in dysthyroid optic neuropathy: a case report
title_fullStr Non-surgical orbital decompression using diuresis in dysthyroid optic neuropathy: a case report
title_full_unstemmed Non-surgical orbital decompression using diuresis in dysthyroid optic neuropathy: a case report
title_short Non-surgical orbital decompression using diuresis in dysthyroid optic neuropathy: a case report
title_sort non-surgical orbital decompression using diuresis in dysthyroid optic neuropathy: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9422236/
https://www.ncbi.nlm.nih.gov/pubmed/35900798
http://dx.doi.org/10.1530/ETJ-22-0078
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