Case of IgG4‐related eye disease accompanied by compressive optic neuropathy

Abstract

PurposeWe report a case of IgG4‐related eye disease accompanied by a compressive optic neuropathy.MethodsA 76‐year‐old woman had hypothyroidism with thyroid ophthalmopathy and was followed at the Kimitsu Central Hospital from July 2015. On October 2016, her right exophthalmos worsened, and a lago ophthalmic keratitis developed in the right eye on February 2017. MRI showed enlargements of the extraocular muscles, and blood tests showed high levels of serum IgG4 (446 mg/dl). On February 27, 2017, her visual acuity decreased to 0.01 OD, and she was referred to the Chiba University Hospital.ResultsAt the first visit, her visual acuity was counting finger OD, and Goldmann perimetry showed a lower right visual field defect. Ocular movements in the right upper field was severely limited because of a lesion that occupied the upper orbit. She was diagnosed with IgG4‐related eye disease accompanied by compressive optic neuropathy.She underwent two cycles of steroid pulse therapy with intravenous antibiotics. Two months later, her decimal visual acuity improved to 0.4 OD, and the ocular movements and the visual field defect were markedly improved. The logo ophthamic keratitis also improved, and the oral prednisolone was tapered to 20 mg. No side effects of the steroid therapy was observed.ConclusionsWhen thyroid ophthalmopathy is markedly exacerbated, ophthalmologists should consider IgG4‐related eye disease that can be masked by lesions associated with thyroid ophthalmopathy.