Hawaiian Eye and Retina 2024: Neuro op mimics of thyroid eye disease

David Hutton of Ophthalmology Times talks with Andrew Lee, MD, about his presentation "Neuro op mimics of thyroid eye disease" at this year's Hawaiian Eye and Retina 2024 Meeting.

Video Transcript

Editor's note - This transcript has been edited for clarity.

David Hutton:

I'm David Hutton of Ophthalmology Times. Hawaiian Eye is taking place once again this year at the Grand Wailea Resort in Maui. Joining me today is Dr Andrew Lee, who is presenting, "Neuro op mimics of thyroid eye disease." Thank you so much for joining us today, Dr Lee. Tell us about this presentation.

Andrew G Lee, MD:

Yeah, so, thyroid eye disease, as you know, is a very common condition, and the most common cause of eye disease in people with thyroid disease is thyroid eye disease. It presents with a bulgey eye proptosis, lid retraction, lid lag, which is the lagging of the lid when they look down, and it can cause double vision or loss of vision. Unfortunately, there are other conditions that can mimic these exact same findings and aren't thyroid eye disease. And so the things that we're going to be talking about are, what are the differentiating and distinguishing features that suggest that it's a mimic of thyroid eye disease and not thyroid eye disease itself? And so we're going to be talking about some of the big red flags for it not being thyroid eye disease, like being strictly one eye only, unilateral, if it's the wrong muscle. So normally in thyroid diseases, the inferior, the medial, the lateral at last and the superior muscle, and if so, if it's the wrong muscle, that's always a big red flag and if you have proptosis, but no major treraction or lid retraction but no proptosis, or if the pattern of the motility deficit is abnormal for thyroid: These are the big red flags that it might be a mimic.

David Hutton:

Ultimately, what can knowing this mean for ophthalmologists and the patients they treat?

Andrew G Lee, MD:

So ophthalmologists need to know that common things are common and the most common presentation of thyroid eye disease is lid retraction, lid lag, proptosis, double vision, and if they have loss of vision from a compressive optic neuropathy, and if so, there's anything atypical about the pattern: wrong side, wrong muscle, wrong deviation, proptosis but no lid retraction, lid reaction but no proptosis, then they should do a scan, and an MRI should be performed. What we're looking for things like lymphoma, carotid cavernous fistula, orbital inflammatory pseudotumor, things that look like the thyroid superficially, clinically, but if there's something funny about it, the imaging studies should be able to answer the question, "is it really thyroid or not?" And ultimately, if the imaging study doesn't answer the question, some of those patients have to come to biopsy, and the biopsy is what shows okay, it's cancer or not cancer, or if it's thyroid disease.