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A case of mini-tenotomy for thyroid ophthalmopathy with diplopia Makiko Hirata 1,2 , Emiko Sugita 2 , Yuka Sogabe 1 , Kiyoshi Suzuma 3 , Toyohiro Tsumura 1 1Department of Ophthalmology, Mitoyo General Hospital 2Department of Ophthalmology, Kagawa Saiseikai Hospital 3Department of Ophthalmology, Kagawa University Faculty of Medicine pp.849-854
Published Date 2024/7/15
DOI https://doi.org/10.11477/mf.1410215222
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Abstract Purpose:Strabismus in primary position without diplopia is usually not indicated for surgery. Here we report a case of mini-tenotomy for thyroid ophthalmopathy with a left hypertropia of 8 prism diopters(PD)at near and downgaze without ocular deviation in the primary position.

Case:A 41-year-old man had a medical history of Graves'disease. Magnetic resonance imaging(MRI)revealed swelling and inflammation in the superior and inferior rectus muscles of the bilateral eyes, and he was diagnosed with thyroid ophthalmopathy. He had a left hypertropia of 26 PD at near and downgaze. A steroid sub-Tenon subcapsular injection was performed twice on the right and three times on the left. Postoperative MRI showed improved inflammatory findings. He had a left hypertropia of 8 PD at near and downgaze, so he suffered from diplopia and neck pain only at downgaze. He started using membrane prism glasses at downgaze, but discontinued them due to ocular and neck pain, and nausea. He was referred to Kagawa Saiseikai Hospital for surgery. A mini-tenotomy of the left superior rectus muscle was performed under local anesthesia. An incision was made in the center of the insertion of the superior rectus muscle. At 1 year postoperative, the reduction in strabismus angle was achieved, with a left hypertropia of 2 PD at near and downgaze. His neck pain disappeared at downgaze. His ocular position remained orthophoria in primary position at both near and far.

Conclusion:These findings suggest that mini-tenotomy may alleviate symptoms in patients with microtropia and thyroid ophthalmopathy who have diplopia only at downgaze.


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電子版ISSN 1882-1308 印刷版ISSN 0370-5579 医学書院

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