Case 2

Thyroid Eye Disease 2^ Graves Disease, OU

Referred to endocrinologist for management and treatment of the underlying thyroid dysfunction. Instructed patient to use preservative-free artificial tears (PF ATs) every hour while awake and a lubricating ointment at bedtime (QHS) to manage ocular surface dryness. If dry eye symptoms are not adequately controlled, consider lid taping or punctal occlusion. Consider referral to oculoplastics for surgical eyelid recession following stabilization of proptosis. If the patient experiences diplopia, consider fresnel prisms or referral for strabismus surgery. At this time, there are no signs of optic neuropathy. If signs of optic nerve compression arise, initiate immediate treatment with oral steroids (prednisone 100 mg PO QD) for 2–14 days and refer to oculoplastics for orbital decompression. RTC in 1 month for evaluation of symptoms, VF 24-2, and OCT nerve.

Educated patient on the diagnosis of thyroid eye disease (TED) secondary to Graves disease. Educated the patient on thyroid eye disease (TED) as a complication of Graves disease, emphasizing that the autoimmune nature of Graves can cause inflammation and swelling of the tissues around the eyes. This may result in symptoms such as eye irritation, dryness, eyelid retraction, proptosis, or double vision.