Dysthyroid optic neuropathy: Demographics, risk factors, investigations, and management outcomes

Indian J Ophthalmol. 2022 Dec;70(12):4419-4426. doi: 10.4103/ijo.IJO_719_22.


Purpose: To analyze the clinical presentations, risk factors, and management outcomes in patients presenting with dysthyroid optic neuropathy (DON).

Methods: This is a retrospective, single-center study carried out on consecutive patients presenting with DON over a period of 4 years (2013-2016). The VISA classification was used at the first visit and subsequent follow-ups. The diagnosis was based on optic nerve function tests and imaging features. Demographic profiles, clinical features, risk factors, and management outcomes were analyzed.

Results: Thirty-seven eyes of 26 patients diagnosed with DON were included in the study. A significant male preponderance was noted (20, 76.92%). Twenty patients (76.9%, P = 0.011) had hyperthyroidism, and 15 (57.69%, P = 0.02) were smokers. Decreased visual acuity was noted in 28 eyes (75.6%). Abnormal color vision and relative afferent pupillary defects were seen in 24 (64.86%) eyes, and visual field defects were seen in 30 (81.01%) eyes. The visual evoked potential (VEP) showed a reduced amplitude in 30 (96.77%, P = 0.001) of 31 eyes and delayed latency in 20 (64.51%, P = 0.0289) eyes. Twenty-six (70.27%) patients were treated with intravenous methyl prednisolone (IVMP) alone, whereas 11 (29.72%) needed surgical decompression. The overall best-corrected visual acuity improved by 0.2 l logMARunits. There was no statistically significant difference in outcome between medically and surgically treated groups. Four patients developed recurrent DON, and all of them were diabetics.

Conclusion: Male gender, hyperthyroid state, and smoking are risk factors for developing DON. VEP, apical crowding, and optic nerve compression are sensitive indicators for diagnosing DON. Diabetics may have a more defiant course and are prone to develop recurrent DON.

Keywords: Dysthyroid optic neuropathy; Thyroid orbitopathy; Visual evoked potential.

MeSH terms

  • Demography
  • Evoked Potentials, Visual
  • Humans
  • Hyperthyroidism* / complications
  • Hyperthyroidism* / diagnosis
  • Hyperthyroidism* / epidemiology
  • Male
  • Optic Nerve Diseases* / diagnosis
  • Optic Nerve Diseases* / epidemiology
  • Optic Nerve Diseases* / therapy
  • Retrospective Studies
  • Risk Factors