Engage with Experts : Orbit Session TED

​ ENGAGE WITH EXPERTS
ORBIT SESSION
THYROID EYE DISEASE

Multiple Choice

A 64-year-old female who is a K/C/O hyperthyroidism presented with  gross diminution of vision in BE .On examination she had both eyes pupil sluggishly reacting to light , lid retraction, proptosis , limitation of movement  and a low CAS. Which of the following is NOT an indication of imaging in this case ?

• To rule out the differential diagnosis of TED

• To assess the clinical activity of TED

• To assess suspected compressive optic neuropathy

• Surgical planning for orbital decompression

Multiple Choice

A 46-year-old male who is a K/C/O diabetes mellitus presented with right eye swelling  .On examination he had  right eye proptosis , limitation of motility and pupil normally reacting to light. His TFT was found to be in normal range . All of the following point towards the diagnosis of TED except ?

• Asymmetric disease with right eye proptosis

  measured by Hilal and Trokel method

• Enlargement of right sided medial rectus with sparing of tendon

• Eyelid retraction with temporal flare

• Euthyroid status

• None

Multiple Choice

A 53-year-old male c/o protrusion of eyeballs and bothersome diplopia since 1 year. He is  a K/C/O hyperthyroidism , S/P IVMP with cumulative dose of 6 g 1 year back .   Examination of BE revealed VA of 20/20  , normal color vision, lower lid retraction , proptosis , LE hypertropia , EOM limitation with diplopia in primary and downgaze . He was planned for bilateral orbital decompression . Which of the following is an indication for orbital decompression in this case?

• Diplopia affecting QOL

• Proptosis

• Lower lid retraction

• Only 1 & 2

• All 1, 2, 3

Multiple Choice

A 44-year-old female who is not a  K/C/O hyperthyroidism presented with right eye upper lid retraction with no proptosis. Her TFT was within normal range , but TSH receptor antibodies were raised . MRI scan showed enlargement of SR-LPS complex, with  raised signal intensity ratio. All are true regarding the presentation and suitable treatment options for the patient except  ?

• She has mild TED ( EUGOGO  classification)

• She has Moderate to severe TED (EUGOGO  classification)

• Intralesional steroids into SR-LPS complex is the preferred treatment

• Systemic steroids is the suitable  treatment option.

Multiple Choice

A 61-year-old male who is  a  K/C/O hyperthyroidism, and uncontrolled diabetes mellitus presented with bilateral proptosis. His VA was 20/20 in BE with normal color vision . There was diplopia and EOM limitation in both eyes . CAS was 6/7. His fundus findings are suggestive of mild NPDR. His TFT was deranged and  TSH receptor antibodies were raised MRI scan showed bilateral EOM large enlargement with mild effacement of fat at apex with signal intensity ratio  s/o high activity and impending optic neuropathy. What is the least suitable modality of treatment for this patient ?

• Intravenous methylprednisolone

• Orbital decompression

• Tocilizumab

• Radiotherapy

Multiple Choice

An 60-year-old male presented with bilateral inactive TED with right eye corneal breakdown. His VA was CFCF in RE and 20/320 in LE . TFT was normal on medications. CT imaging showed enlarged EOMs with apical crowding. The patient was planned for both eye orbital decompression . Which of the following is true for this patient on preoperative evaluation on CT scan?

• Fat predominant disease 

• Adequately Deep orbit

• Adequate position of cribriform plate

• All of the above

Multiple Choice

An 57-year-old male , K/C/O hyperthyroidism , S/P IVMP ( 1 year ago) presents with RE lid swelling. On examination , RE VA 20/25, color vision abnormal , grade 1 RAPD, with normal disc. There was RE proptosis with EOM limitation.  TFT was normal on medications. Barrett’s index was calculated and was found to be greater than 67%. Which of the following is the correct calculation of Barrett’s index ?

 

• B+C/A

• A/B+C

• A+B/C

• C/A+B