Greater Proptosis Is Not Associated With Improved Compressive Optic Neuropathy in Thyroid Eye Disease

Tavish Nanda, Kristen E. Dunbar, Ashley Campbell, Ryan M. Bathras, Michael Kazim

Research output: Contribution to journalArticle

Abstract

PURPOSE: Despite the paucity of supporting data, it has generally been held that proptosis in thyroid eye disease (TED) may provide relative protection from compressive optic neuropathy (CON) by producing spontaneous decompression. The objective of this study was to investigate this phenomenon in patients with bilateral TED-CON.

METHODS: We retrospectively reviewed the charts of 67 patients (134 orbits) with bilateral TED-CON at Columbia-Presbyterian Medical Center. Significant asymmetric proptosis (Hertel) was defined as ≥ 2 mm. Significant asymmetric CON was defined first, as the presence of an relative afferent pupillary defect. Those without an relative afferent pupillary defect were evaluated according to the TED-CON formula y = -0.69 - 0.31 × (motility) - 0.2 × (mean deviation) - 0.02 × (color vision) as previously established for the diagnosis of TED-CON. A difference in the formula result ≥ 1.0 between eyes was considered significant. Patients were then divided into 4 groups.

RESULTS: Forty-one of 67 patients demonstrated asymmetric CON (29 by relative afferent pupillary defect, 12 by formula). Twenty-one of 67 patients demonstrated asymmetric proptosis. Only 5 of 12 (41.6%) of the patients who had both asymmetric proptosis and asymmetric CON (group 1) showed greater proptosis in the eye with less CON. Twenty-nine patients (group 2) showed that asymmetric CON occurred despite symmetrical proptosis. Seventeen patients (group 3), showed the inverse, that asymmetric differences in proptosis occurred with symmetrical CON.

CONCLUSION: Despite commonly held assumptions, our results suggest that greater proptosis is not associated with improved TED-CON. Combining groups 1 to 3-all of which demonstrated asymmetry of either proptosis, CON, or both-91.4% of patients did not show a relationship between greater proptosis and improved CON.

Original languageEnglish (US)
Pages (from-to)S72-S74
JournalOphthalmic Plastic and Reconstructive Surgery
Volume34
Issue number4S Suppl 1
DOIs
StatePublished - Jul 1 2018

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Optic Nerve Diseases
Exophthalmos
Eye Diseases
Thyroid Diseases
Pupil Disorders
Color Vision
Orbit
Decompression

ASJC Scopus subject areas

  • Surgery
  • Ophthalmology

Cite this

Greater Proptosis Is Not Associated With Improved Compressive Optic Neuropathy in Thyroid Eye Disease. / Nanda, Tavish; Dunbar, Kristen E.; Campbell, Ashley; Bathras, Ryan M.; Kazim, Michael.

In: Ophthalmic Plastic and Reconstructive Surgery, Vol. 34, No. 4S Suppl 1, 01.07.2018, p. S72-S74.

Research output: Contribution to journalArticle

Nanda, Tavish ; Dunbar, Kristen E. ; Campbell, Ashley ; Bathras, Ryan M. ; Kazim, Michael. / Greater Proptosis Is Not Associated With Improved Compressive Optic Neuropathy in Thyroid Eye Disease. In: Ophthalmic Plastic and Reconstructive Surgery. 2018 ; Vol. 34, No. 4S Suppl 1. pp. S72-S74.
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abstract = "PURPOSE: Despite the paucity of supporting data, it has generally been held that proptosis in thyroid eye disease (TED) may provide relative protection from compressive optic neuropathy (CON) by producing spontaneous decompression. The objective of this study was to investigate this phenomenon in patients with bilateral TED-CON.METHODS: We retrospectively reviewed the charts of 67 patients (134 orbits) with bilateral TED-CON at Columbia-Presbyterian Medical Center. Significant asymmetric proptosis (Hertel) was defined as ≥ 2 mm. Significant asymmetric CON was defined first, as the presence of an relative afferent pupillary defect. Those without an relative afferent pupillary defect were evaluated according to the TED-CON formula y = -0.69 - 0.31 × (motility) - 0.2 × (mean deviation) - 0.02 × (color vision) as previously established for the diagnosis of TED-CON. A difference in the formula result ≥ 1.0 between eyes was considered significant. Patients were then divided into 4 groups.RESULTS: Forty-one of 67 patients demonstrated asymmetric CON (29 by relative afferent pupillary defect, 12 by formula). Twenty-one of 67 patients demonstrated asymmetric proptosis. Only 5 of 12 (41.6{\%}) of the patients who had both asymmetric proptosis and asymmetric CON (group 1) showed greater proptosis in the eye with less CON. Twenty-nine patients (group 2) showed that asymmetric CON occurred despite symmetrical proptosis. Seventeen patients (group 3), showed the inverse, that asymmetric differences in proptosis occurred with symmetrical CON.CONCLUSION: Despite commonly held assumptions, our results suggest that greater proptosis is not associated with improved TED-CON. Combining groups 1 to 3-all of which demonstrated asymmetry of either proptosis, CON, or both-91.4{\%} of patients did not show a relationship between greater proptosis and improved CON.",
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