| Sumario: | Background: A condition generally associated with hyperthyroidism, thyroid-associated ophthalmopathy may present with signs that vary from patient to patient. Diplopia is one of the most common and debilitating of manifestations, and it can be difficult to treat effectively. Case Report: An adult female presented with thyroid-associated ophthalmopathy, complaining of "bulging, dry, gritty" eyes (OS worse than OD) and double vision when looking to the extreme right or left. Two weeks of dry eye therapy OU was successful, but intermittent diplopia persisted. The patient indicated that the diplopia was "not bothersome." Eight weeks after the initial examination, the patient reported constant diplopia in primary gaze that threatened her ability to remain independent. Prism was of no benefit. Occlusion of a whole spectacle lens resolved the diplopia, but she felt unsafe driving. Thus, a procedure was devised to occlude only the precise sector of one spectacle lens as needed to inhibit the constant binocular diplopia. This allowed the use of the total effective visual field of both eyes in primary gaze, enabling the patient to drive safely and to remain independent. Conclusion: Diplopia in thyroid-associated ophthalmopathy often varies from intermittent to constant, with or without spontaneous resolution. If binocular diplopia is constant, and prism is determined to be of no benefit, monocular partial/sector occlusion of a spectacle lens may be a viable option for inhibiting the diplopia. This occlusion therapy is unique in allowing optimal use of the total effective visual field of both eyes, and it can be used temporarily or chronically as needed.
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