Abstract
Background
The sudden onset of painful diplopia necessitates careful consideration and diagnosis due to the extensive range of potential differential diagnoses. Patients with thyroid-associated ophthalmopathy (TAO) typically exhibit proptosis, eyelid edema, eyelid retraction, and lid lag, herein we report a case of TAO patient whose initial symptom was diplopia accompanied by pain; however, the absence of obvious eyelid signs led to an easily misdiagnosed condition.
Case presentation
A 42-year-old male patient presented to our neurology department with a four-month history of diplopia and eye pain. The diagnosis of TAO was made after a four-month period from the onset of diplopia. Local orbital injection of triamcinolone acetonide and precision radiotherapy were administered to the patient. Following treatment, there was a significant improvement in subjective symptoms, including diplopia and pain; however, complete recovery of eye mobility was not achieved.
Conclusion
For patients presenting with diplopia as the initial symptom, even in the absence of evident TAO eyelid signs, it is crucial to obtain a comprehensive medical history and conduct thyroid function tests along with orbital enhanced MRI scans to minimize the risk of misdiagnosis. Accurate early-stage diagnosis enables targeted treatment interventions, thereby optimizing patient prognosis.