client with Graves' disease complains of eye pain and visual disturbances. Which of the following complicatio… - AIIMS M.Sc. Nsg Entrance exam-2026

AIIMS M.Sc. Nsg Entrance exam-2026

Medical & Surgical Nursing

Medium

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

Graves' disease can trigger an autoimmune response against the tissues behind the eye, a condition called Graves' ophthalmopathy or Thyroid Eye Disease (TED).
This response causes inflammation and swelling of the extraocular muscles and orbital fat within the fixed, bony orbit.
The swelling increases pressure behind the eyeball (retrobulbar pressure), which directly compresses the optic nerve.
This complication, known as dysthyroid optic neuropathy, is the cause of the patient's eye pain and visual disturbances and can lead to vision loss if not treated urgently.

Option A: Glaucoma involves increased pressure inside the eyeball (intraocular pressure), not pressure from tissues behind the eye. While glaucoma can be associated with Graves' disease, the direct compression from swollen orbital tissue is the more specific and likely cause of these symptoms.
Option C: This is a symptom, not a complication. The question asks for the underlying pathological process causing the patient's complaints.
Option D: Retinopathy is damage to the retina. The primary mechanism of vision loss in Graves' ophthalmopathy is damage to the optic nerve (optic neuropathy), not the retina.

Visual 1: Diagram - A sagittal view of the eye and orbit comparing a normal eye to one with Graves' ophthalmopathy. The visual should highlight the swollen extraocular muscles and orbital fat pressing on the optic nerve.
Visual 2: CT Scan - An axial CT image of the orbits showing marked enlargement of the medial and inferior rectus muscles, characteristic of Thyroid Eye Disease, and crowding at the orbital apex where the optic nerve is located.

Clinical Relevance

Nursing practice connection: Use the key finding related to Complications of Graves' Disease (Graves' Ophthalmopathy) to guide bedside assessment, documentation, and the next nursing action.
Nurses must recognize that new-onset eye pain and vision changes in a patient with Graves' disease can signal optic nerve compression, which is a sight-threatening emergency requiring immediate ophthalmologic consultation.
Key nursing assessments include checking for changes in visual acuity, color vision (often tested with a red object), and visual fields, as well as assessing for proptosis and lid retraction.
Patient education is crucial, including measures to protect the eyes (e.g., artificial tears, sunglasses) and elevating the head of the bed to reduce periorbital edema.

How to Approach the Question

First, identify the key elements in the question: a patient with a known diagnosis (Graves' disease) and specific new symptoms (eye pain, visual disturbances).
Recall the major complications associated with Graves' disease, particularly its effect on the eyes (Graves' ophthalmopathy/Thyroid Eye Disease).
Analyze the options to distinguish between a root cause (complication) and a result (symptom). 'Visual disturbance' is a symptom, so it can be eliminated as the underlying complication.
Differentiate the remaining pathological options. The pathophysiology of Graves' ophthalmopathy involves swelling of tissues behind the eye.
Contrast this with glaucoma (pressure inside the eye) and retinopathy (damage to the retina). The swelling behind the eye directly leads to pressure on the optic nerve.
Conclude that optic nerve pressure is the most direct and likely complication causing the described symptoms.

Concept Tested & Keywords

Concept Tested: Complications of Graves' Disease (Graves' Ophthalmopathy)
Stem keywords: Graves' disease, eye pain, visual disturbances
Lead-in keywords: most likely
Clinical cues: A known diagnosis of Graves' disease is the primary clue.
Clinical cues: The combination of eye pain and visual disturbances points towards a serious orbital complication.

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