Central Retinal Vein Occlusion with Chorioretinal Folds Secondary to Active Thyroid Eye Disease

A 54-year-old man with acute thyroid eye disease (TED) presented with decreased vision (20/30 in the right eye [OD] and 20/60 in the left eye [OS]) and left afferent pupillary defect. Periorbital erythema and edema, chemosis, and severe resistance to retropulsion were noted (Fig 1). Computed tomography showed extraocular muscle enlargement with apical crowding (Fig 2). OCT and funduscopy showed disc edema with dilated, tortuous retinal veins OS and macular chorioretinal folds in both eyes (OU) (Fig 3A-C). Fluorescein angiography demonstrated delayed venous filling OS and chorioretinal folds in OU (Fig 4A-B). A PubMed search revealed a prior case of central retinal vein occlusion (CRVO) occurring in active TED; however, this is the first reported case of a CRVO with chorioretinal folds due to increased orbital pressure and venous congestion secondary to TED. (Magnified version of Fig 1-4 is available at www.aaojournal.org.)