Late onset dysthyroid optic neuropathy

We report three rare occurrences of late onset dysthyroid optic neuropathy. We reviewed each case in detail and found that these middle-aged patients developed onset of optic neuropathy 7 to 12 years following stabilization of clinically significant, stable ophthalmopathy. There was no corresponding reactivation of orbital inflammatory symptoms or signs. Characteristic of a Graves' ophthalmopathy, the vision was responsive to either corticosteroid or surgical decompression, or to a combination thereof. None of the patients had diabetes, hypertensive, or cardiovascular disease. We hypothesize that in these unique cases possible mechanical vascular factors may have induced decompensation of optic nerve function in otherwise stable disease.