A 71-year-old woman came to our service with loss of visual acuity in the right eye (OD) for several months.
Personal systemic history included Graves-BedowÆs disease diagnosed in 1984, euthyroid with levothyroxyna (Levothyroxyna) (Levothyroxine ®), Merck and Chemistry, Spain.
Visual acuity (VA) in RE was 0.125 and in left eye (LE) 0.5.
In the RE stood out the presence of a dense nuclear cataract.
Presents a non-contrast ophthalmopathy with an exophthalmos of 21 mm in the RE and 23 mm in the LE.
CT showed the presence of bilateral proptosis major in the left eye, with normal musculature.
The applanation ocular tension in the RE was 19 mmHg and in the LE was 18 mmHg.
The rest of the exploration was compatible with normality.
Right cataract extraction and intraocular lens implantation were performed with retrobulbar anesthesia without complications.
5 cc of a mixture of 2% lidocaine with 0.75% bupivacaine were used in anesthesia.
The postoperative VA one week after surgery was 0.6 without correction.
35 days after surgery the patient presented to the emergency department with diplopia that prevented her normal life.
In the following weeks, a 25 mm proptosis with severe keratopathy and generalized pruritus appeared in the right eye.
The VA in this eye was hand movement.
An asymmetric bilateral exoftmosis was observed in the orbital CT, with an increase in the extrinsic muscles in the right orbit compressing the orbital apex.
Treatment was performed with 1 gram of methylprednisolone daily (U Resident®, Avantis Pharma orbit, SA; Madrid) for 3 days without radiotherapy because it was offered.
The study of thyroid hormones during this period was normal with a T4 of 0.96 ng/dl and a TSH of 0.1 uIU/ml.
