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Refractive change in thyroid eye disease (a neglected clinical sign)

¹ Sydney Eye Hospital, Sydney, Australia
² Save Sight Institute, Department of Ophthalmology and Eye Health, University of Sydney, Australia
³ Department of Ophthalmology and Visual Sciences, University of Adelaide, Australia

Correspondence to:
Correspondence to:
Dr R Ghabrial
Sydney Oculoplastic Surgery, Level 7, 229 Macquarie Street, Sydney, NSW 2000, Australia; rafg{at}bigpond.com

ABSTRACT
Background/aims: The literature on refractive change in thyroid eye disease (TED) is limited. This study documents the refractive change in patients with TED undergoing orbital decompression. The authors propose possible mechanisms for their acquired refractive error.

Methods: This is a retrospective observational case study of five patients with progressive TED. Their detailed eye examinations including refractive state preoperatively and postoperatively are presented.

Results: An acquired hypermetropic shift with active TED before orbital decompression of up to 3.75D spherical equivalent refraction (SER) is reported in one patient. Post-orbital decompression, an induced myopic shift of between 1.00–2.50D SER for all patients is observed, noted to range from 1 day following surgery to up to 9 months, dependent on the availability of data. Axial length increased in two cases corresponding to postoperative myopic shift. Magnetic resonance imaging findings of one patient demonstrate flattening of the posterior pole as a cause of the acquired preoperative hypermetropia.

Conclusions: TED has a significant effect on the refractive state of patients. The proposed mechanism of acquired hypermetropia relates to increased volume of orbital contents with flattening of the posterior globe. This is reversed with successful orbital decompression. Documentation of refractive error in all cases of progressive TED is recommended. Progressive acquired hypermetropia may be suggestive of TED activity.

Keywords: thyroid eye disease; refraction; spherical equivalent refraction; visual acuity; orbital decompression

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