A patient with thyroid eye disease (Graves' orbitopathy) has proptosis of 22 mm (normal < 18 mm), compressive optic neuropathy, and corneal exposure. The most urgent intervention is:
- A High-dose intravenous methylprednisolone pulse therapy
- B Squint surgery for diplopia correction
- C Orbital decompression surgery (bone removal ± fat decompression) ✓
- D Selenium supplementation and smoking cessation
Correct answer: C. Orbital decompression surgery (bone removal ± fat decompression)
Explanation
Dysthyroid optic neuropathy (DON) is a sight-threatening emergency in thyroid eye disease. While IV steroids may provide temporary response, orbital decompression surgery is the definitive urgent treatment for compressive optic neuropathy with proptosis causing corneal exposure. Strabismus surgery is performed last in the rehabilitative sequence (after disease inactivity, then decompression, then strabismus, then lid surgery). Selenium is used in mild active disease.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.