SUCCESSFUL MANAGEMENT OF HYPERTROPIA RELATED THYROID EYE DISEASE WITH HEMI HANG-BACK PROCEDURE
Introduction: Hypertropia in thyroid eye disease (TED) is uncommon condition which may cause visual and aesthetical problem with quality of life disturbance.
Case Illustration: A 44-year-old woman presented with a squint on the right eye with bilateral diplopia for 18 months. She had history of hyperthyroidism for two years which had been treated with thiamazole and propanolol for 1 year and methylprednisolone for 6 months. Visual acuity of both eyes was 20/20 with no sign of active inflammation and optic neuropathy. Ocular motility showed restriction in lateral and down gaze. Inferior restriction was found in forced duction test. Hypertropia of 40 prism diopters was remarkably seen in Krimsky test. We performed strabismus surgery after patient was in inactive stage and reach euthyroid state without treatment for 6 months. During surgery we found muscle enlargement and fibrous tissue of superior rectus muscle. Superior rectus recession for six milimeters with additional hemi-hang back procedure for two milimeters had been performed with significant improvement of diplopia. Ocular motility exercise was suggested to reach binocular vision.
Discussion: Hypertropia in TED was caused by extraocular muscle fibrosis due to inflammation and lymphocytic infiltration. Strabismus surgery was aimed at diplopia correction in primary position. Surgical procedure, extra ocular muscles in which surgery must be done and its surgical dosage should be considered carefully.
Conclusion: This case showed restrictive hypertropia in TED with distressing symptoms and challenging management. Hemi hang-back procedure is should be considered in difficult case.
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