Dysthyroid optic neuropathy (DON) is a sight threatening emergency which occurs in 3-5% of patients with thyroid eye disease. The purpose of this audit was to evaluate the outcomes for patients undergoing orbital decompression for DON in a DGH setting.

A retrospective review of the notes, photographs and imaging for all patients who had orbital decompression surgery for DON between August 2011 and Dec 2014 in Doncaster Royal infirmary.

Six eyes with DON underwent decompression surgery (4 patients: 1 male and 3 female). Ages ranged from 41-53, all 4 patients were smokers. At diagnosis of DON, 6 eyes had reduced visual acuity, 5 had visual field changes, 4 had impaired colour vision, 1 had an RAPD, 1 had optic nerve head swelling and 1 had choroidal folds. All patients had orbital apex crowding on CT.
All patients received high dose iv methylprednisolone as part of their initial treatment. Three patients also received radiotherapy, 1 prior to orbital decompression and 2 following decompression. Four eyes underwent medial wall decompression and two eyes had 3 wall decompression. Following decompression surgery all patients experienced reduced proptosis (mean absolute reduction 2.9mm, range 0.5-5.5mm). At final follow up (which ranged from 8-33 months) best corrected visual acuity was 6/9 in 2 of the affected eyes and 6/5 in 4 of the affected eyes; colour vision was normal in all but one patient and no patients had an afferent pupil defect.

DON is a serious, potentially blinding condition which involves a multi-disciplinary approach to treatment. Orbital decompression often forms part of this treatment plan and our results from a DGH setting show sound outcomes for this group of patients.