Refinement of the Constellation of Findings at presentation Clinical and Soft-Tissue Computed Tomographic Predictors of Dysthyroid Optic Neuropathy Refinement of the Constellation of Findings at presentation R4 한재형/Pf.양석우

Dysthyroid optic neuropathy 5% of cases Serious complication of TAO leading to vision loss Accurate and prompt recognition and management is essential.

Pathogenesis Compression of optic nerve Deceased blood supply Retrobulbar pressure Optic nerve stretch

Risk factor Aging Male Diabetes mellitus

Diagnostic clues Visual acuity RAPD Color vision Visual field Evoked Potential

Clinical examinations Inflammatory score of the VISA scale

Clinical examinations Marginal reflex distance Lower eyelid retraction Lagophthalmos Levator function Interpalpebral fissure distance Epitheial keratopathy Fat prolapse Total ductions Intraocular pressure in different gaze

Radiologic examinations Apical crowding Normal Mild, 1%-25% Moderate, 26%-50% Severe, >50%

Radiologic examinations Proptosis perpendicular line from the scleral margin to the interzygomatic line on axial scans Maximum optic nerve sheath diameter Lacrimal gland displacement Low-density foci in the extraocular muscles Superior ophthalmic vein margin irregularity Presence of tendon enlargement Anteriorposterior globe diameter Intracranial fat prolapse

Results 189 orbits from 99 consecutive patients

Discussions Marginal reflex distance Interpalpebral fissures Levator function Newly statistically confirmed parameters in this study Small hypodensities fibroblasts into adipocytes These occur in the later stages of disease inactive phase of the disease

Conclusion Clinical features CT evaluation are able to predict the presence of DON with high sensitivity, specificity, PPV and NPV.

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