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  • Graves’-related blindness reversible with decompression surgery

    By Michael Vaphiades, DO
    Neuro-Ophthalmology/Orbit

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    Three consecutive patients blind from thyroid-related compressive optic neuropathy were treated with orbital decompression and all experienced significant visual recovery, one of them to 20/20 in both eyes.

    This case series highlights the benefit of this treatment in patients with a poor visual prognosis.

    The authors say that to the best of their knowledge, visual recovery in patients with no light perception secondary to compressive optic neuropathy in thyroid eye disease has not been described.

    The surgical technique used in the three cases consisted of a transcaruncular medial wall and posterior medial floor orbital decompression.

    The first patient, a 68-year-old woman, had no light perception in the right eye of three months’ duration and counting fingers in the left eye before surgery but recovered visual acuity to 20/400 in the right eye and 20/50 in the left eye. The second patient was a 43-year-old man who had counting fingers vision in one eye and no light perception in the other of five days’ duration before surgery and recovered visual acuity to 20/20 with full color vision. The third patient had no light perception in the right eye of three months’ duration and 20/40 in the left. Six months after surgery, visual acuity was 20/60 in the right eye and 20/25 in the left with full color vision.

    The authors note that no light perception secondary to compressive optic neuropathy for more than 48 hours and after operative decompression has a very poor visual prognosis.

    This case series shows that axonal death may not occur up to three months after total nerve function loss and that decompression may still be effective in patients with prolonged no light perception. They say this report is important because complete visual loss is often considered a contraindication for decompression.

    However, since this case series only provides level IV evidence to recommend treatment, they conclude that more studies are necessary to validate this indication for orbital decompression.