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Carcinoid tumour metastatic to the choroid.

One week later the patient complained of horizontal diplopia. On examination visual acuities were unchanged, but the conjunctiva was diffusely inflamed and chemosed bilaterally. Colour vision was reduced on both sides on testing with Ishihara plates (9/15 right and 8/15 left). There was no proptosis but the eyes felt hard to retropulsion on both sides. The intraocular pressures were now 34 mm Hg and 32 mm Hg, increasing to 40 mm Hg and 41 mm Hg on upgaze. A diagnosis of dysthyroid eye disease was made and the patient treated with acetazolamide 250 mg three times daily and prednisolone 80 mg daily. Thyroid function tests, full blood count, erythrocyte sedimentation rate, urea and electrolytes were all normal. A computed tomography scan showed marked increase in size of all the extraocular muscles but particularly the medial rectus on both sides (Fig 1) with crowding of the orbital apex suggestive of dysthyroid eye disease. Over the next week there was gradual improvement in both symptoms and clinical signs. Steroids were gradually reduced and at his last visit 4 weeks after the episode the visual acuities had returned to 6/6 right and 6/6 left with all Ishihara plates seen on both sides. The chemosis had resolved and there was a full range of extraocular movements.