42 year old male patient admitted to our hospital with recurrent episodes of conjunctivitis and episcleritis that did not improve with conventional treatment.
He did not refer personal history or habits of interest, only about one episode per day was reported.
Corrected visual acuity (VA) was found in both eyes; biomicroscopic findings included conjunctival chemosis +/++++ and superficial edema.
The patient did not have bladder augmentation or exophthalmos and the intraocular pressure (IOP) was 13/11 mmHg.
Classification according to the NONSPECS index of 2-b, 5-a.
Basic laboratory tests (biochemistry and blood count) were normal, thyroid hormones (T3,T4,TSH) were elevated.
The patient was referred to the endocrinologist with the diagnosis of mild-moderate glaucoma with antithyroid treatment and topical ocular treatment.
In subsequent revisions, progression of disease towards a moderate-severe stage was observed, with worsening of biomicroscopic signs, development of right retraction (24I in the left hemisphere and 24 mm in the left eye and 122 mm in the lower).
An octreoscan was performed, consisting of an injection of 6 mg of intravenous In111-octreotide and planar imaging study by photon emission tomography at four and twenty-four hours.
These images revealed the presence of activity at the orbital level using a qualitative contrast method comparing the uptake with the background (occipital bone tissue), so treatment was started with lanreotide 90 mg every 3 weeks followed by an intramuscular injection.
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After treatment, the test was repeated, demonstrating a decrease in orbital uptake.
The corrected VA was 1 in the RE and 0.9 in the LE, with a mild inferior corneal epitheliopathy persisting.
IOP was 17/14 mm Hg with topical hypotensive treatment in RE and trabeculectomy in OI (one month after starting treatment) due to sustained hypertension (≈36 mmHg) unresponsive to medical treatment.
The exophthalmoscopy was performed at 22 mm AO and the retraction was achieved at 2 mm upper and 1 mm lower AO while waiting for surgery.
