Thyroid eye disease with dysthyroid optic neuropathy: Dramatic visual recovery following orbital decompression—A case report

Thyroid eye disease (TED), also known as Graves’ orbitopathy, is an autoimmune inflammatory disorder of the orbit that may lead to vision-threatening complications such as dysthyroid optic neuropathy (DON). DON results from compression of the optic nerve at the orbital apex by enlarged extraocular muscles and inflamed orbital tissues and constitutes an ophthalmic emergency. We report a case of active TED with progressive visual loss and steroid-refractory DON, in which timely bilateral orbital decompression resulted in marked and rapid improvement in visual acuity. This case highlights the importance of early recognition of optic nerve involvement and prompt escalation to surgical management when medical therapy fails.