A 56-year-old male with a history of laryngeal neoplasia, type 2 diabetes mellitus, former smoker and former drinker, diagnosed with hyperthyroid crisis.
At that time, the patient presented an exophthalmos of 23 and 25 mm, without limitation of eye movements, visual acuity of 0.7 with correction in both eyes (AO), fundus of the right eye with internal diabetic sharpness and thickening.
One month later she presented retraction of both eyelids with limitation of upper and lateral motility in BE.
Ocular tension (OT) was 26 mmHg in right eye and 25 mmHg in left eye.
The patient was treated with topical beta-blocker and systemic corticosteroid treatment with 1 gr/24 h of intravenous methylprednisolone 3 pulses.
Exophthalmos and OT increased, so topical anhydrase inhibitors were added, and the patient was referred for orbital radiotherapy with 2000 Gy.
The evolution was unfavourable; proptosis increased to 27 and 30 mm and CAT confirmed the increase of the thickening of the internal rectus muscles.
Palpitation was present in the left eye and corneal exposure resulting in bilateral orbital compression with fracture of the inferior, internal and external walls.
Hormonal control revealed a severe hypothyroid crisis (TSH 44.5 uUI/mL (0.5-5.0), T3 42 ng/dL (60-180), T4 Total 02.4 ng/dL (5.0-1.8)., T4
The exophthalmos continued to worsen, before which a lipectomy was performed in both orbits (1 cc of fat), which shows muscles and orbital tissues infiltrated, enucleation of the left internal eye and absolute glaucoma, tarsal.
Thyroid hormones then normalized (TSH 14.3, T4 Total 5.9 and T4 count decreased overt 1.1), proptosis was evident and ocular motility increased, opening up tarsals.
The examination of the RE showed a VA of 0.1 as a result of the optic neuropathy, OT of 18 mmHg, severe diabetic retinopathy.
The patient remains stable after 9 years of evolution.
