A Stare With a Catch
neuro ophthalmology
Patient Demographics
Age: 71 years
Gender: Female
History of Presenting Complaint
Presented with a several-month history of a "staring" appearance to both eyes, noticed by the patient and her family, along with mild ocular grittiness.
Past Medical History
- Known Graves' disease (hyperthyroidism), diagnosed several years prior to presentation
- Current smoker — a significant modifiable risk factor for the severity of thyroid eye disease
Examination Findings
Visual Acuity
OD: 6/6. OS: 6/6
Pupils
Equal and reactive, no RAPD
Extraocular Movements
No upgaze bilaterally; other directions of gaze full
Anterior Segment
Lids: bilateral upper lid retraction, most prominent in primary gaze and on attempted upgaze; lids "catch up" with the limbus (retraction largely resolves) on attempted downgaze
Posterior Segment
No evidence of compressive optic neuropathy at this time (normal VA, no RAPD, no colour vision deficit)
Which investigations would you choose?
Try to decide before revealing the results. You have 2 attempts.
Thyroid function tests
TSH-receptor antibody (TRAb) testing
Colour vision and formal visual acuity assessment
Clinical photography and orthoptic motility assessment
Lumbar puncture for oligoclonal bands
0 of 4 investigations selected
Investigations (Locked)
Complete the investigation selection question above to unlock the full investigation results.