Central Retinal Vein Occlusion and Compressive Optic Neuropathy Secondary to Thyroid Eye Disease

Visual acuity was 20/60 with mild elevation of the optic nerve on ophthalmoscopy and early nerve fiber bundle defect on visual field testing. [...]reduced venous drainage and proptosis-related stretching of the optic nerve may induce ischemia, which may in turn contribute to DON progression.3 Impaired outflow of the superior ophthalmic vein can similarly cause intraocular venous stasis and is likewise a risk factor for CRVO. Devoto et al. reported a case series of patients with prolonged NLP vision who achieved visual recovery following delayed orbital decompression, highlighting the potential for optic nerve axons to survive prolonged DON.8 Decompressive surgery has also been reported to reverse CRVO in severe DON, which may ameliorate retinal ischemia and contribute to better visual outcomes.4 Taken together, the limited data on management of sight-threatening DON suggest a low threshold to consider orbital decompressive surgery to mitigate severe vision loss, particularly if optic nerve edema or chorioretinal signs of increased orbital pressure are present.