Combined corticosteroid and radiotherapy in refractory dysthyroid optic neuropathy—an alternative medical therapy to surgery: A case report

Dysthyroid optic neuropathy (DON) is a severe vision-threatening complication of thyroid eye disease requiring urgent intervention to prevent permanent vision loss. Although surgical decompression remains the gold standard for refractory cases, recent studies suggest that combined medical therapy may offer a viable, less invasive alternative. We report a 58-year-old woman with progressive unilateral visual loss, proptosis, and reduced color vision despite ongoing European Group on Graves’ Orbitopathy-recommended steroid therapy. Clinical evaluation and imaging confirmed DON. Along with high-dose intravenous corticosteroids, orbital radiotherapy (20 Gy in 10 fractions) was initiated. The patient showed marked improvement in vision, color perception, and orbital congestion within four weeks. Follow-up imaging revealed reduced extraocular muscle belly and improved optic nerve contour. This case suggests that combined corticosteroid and radiotherapy may be an effective alternative to surgical decompression in selected DON patients. Our findings support increasing evidence favoring combined non-surgical therapy when surgery is high-risk or undesirable.