What is the greatest threat to vision as a result of Thyroid Eye Disease?

• A. Hyphema
• B. Retinal detachment
• C. Optic nerve compression
• D. NVG

Answer: (C)

Compressive optic neuropathy from Thyroid Eye Disease is the main vision threat. When the orbit is crowded with swollen muscles and inflammatory tissue, the optic nerve can be pressed at the orbital apex, compromising its blood supply and damaging nerve fibers. This can lead to rapid, potentially irreversible loss of central vision and color vision if not treated quickly. Look for signs like decreased visual acuity, changes in color vision, and an afferent pupillary defect, and recognize that urgent management (often high‑dose IV steroids and sometimes surgical decompression) is needed to relieve pressure. Other TED-associated issues like hyphema, retinal detachment, or neovascular glaucoma are less immediate threats to vision in typical cases of TED.