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This 49-year-old woman presents with a complaint of progressive blurring vision right eye more than left eye, with transient visual obscurations, occasional orbital pain, and horizontal binocular diplopia. Medical history is positive for hyperthyroidism. She is status post radioactive iodine treatment. She also has insulin dependent diabetes mellitus, hypertension, irregular heart beat, and sinusitis.

1.	What is the most likley diagnosis:
	a. orbital pseudotumor b. diabetic retinopathy and neuropathy c. thyroid orbitopathy d.  hypertensive retinopathy and neuropathy
2.	What is the most likely reason for the visual field changes:
	a. optic nerve insult secondary to orbital inflammation b. optic nerve insult secondary to optic nerve compression c. optic nerve insult secondary to diabetes d.  optic nerve insult secondary to hypertension
3.	What is the next best step for this patient:
	a. improved blood sugar control b. closer blood pressure control c. start systemic steroids d.  surgical orbital decompression

For answers to the above, click here on or after December 14, 2004.