Neuro-ophthalmology and pupils: thyroid optic neuropathy: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Neuro-ophthalmology and pupils: thyroid optic neuropathy

Sample item

A woman with Graves disease has bilateral proptosis, little congestion, falling visual acuity and dull colours. The discs look normal and CT shows enlarged muscles crowding the orbital apex. What is the best next treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Intravenous methylprednisolone, with decompression if no response

Dysthyroid optic neuropathy is compression of the nerve at the apex by enlarged muscles and is a sight-threatening emergency. Intravenous methylprednisolone is the first treatment, and urgent orbital decompression if vision does not improve. Radioiodine can worsen eye disease.

Option by option

  • A. Radioiodine therapy at once

    Radioiodine may aggravate thyroid eye disease and does not decompress the nerve.

  • B. Topical lubricants alone

    Lubricants help dryness but do not relieve optic nerve compression.

  • C. Intravenous methylprednisolone, with decompression if no response (correct)

    Correct. Steroid reduces swelling and decompression relieves apical compression.

  • D. Observation until the thyroid is euthyroid

    Waiting risks permanent optic nerve damage.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is C, Intravenous methylprednisolone, with decompression if no response. Dysthyroid optic neuropathy is compression of the nerve at the apex by enlarged muscles and is a sight-threatening emergency.

Why is "Radioiodine therapy at once" not the answer?

Radioiodine may aggravate thyroid eye disease and does not decompress the nerve.

Why is "Topical lubricants alone" not the answer?

Lubricants help dryness but do not relieve optic nerve compression.

Why is "Observation until the thyroid is euthyroid" not the answer?

Waiting risks permanent optic nerve damage.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: thyroid optic neuropathy in Ophthalmology. Intravenous methylprednisolone is the first treatment, and urgent orbital decompression if vision does not improve. Radioiodine can worsen eye disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuro-ophthalmology and pupils: thyroid optic neuropathy?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.