A 41-year-old woman with Graves' disease, currently euthyroid on carbimazole, reports worsening right-sided eye pain and blurring of vision over five days. Visual acuity is 6/36 in the right eye, she cannot identify red colour correctly, and there is a relative afferent pupillary defect with mild proptosis. What is the immediate management?
- A Continue carbimazole and review vision after achieving deep euthyroidism
- B Intravenous methylprednisolone with urgent orbital decompression if vision does not improve ✓
- C Radioactive iodine ablation of the thyroid
- D Prism glasses and lubricating drops with outpatient follow-up
Correct answer: B. Intravenous methylprednisolone with urgent orbital decompression if vision does not improve
Explanation
Falling acuity, defective colour vision, and a relative afferent pupil signal dysthyroid optic neuropathy, a sight-threatening complication of Graves' orbitopathy caused by apical crowding of the optic nerve. High-dose intravenous glucocorticoid is first line, with orbital decompression reserved for inadequate response within one to two weeks. Radioiodine can worsen active eye disease, and conservative measures are appropriate only for mild orbitopathy.
Reference: Williams Textbook of Endocrinology, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.