Graves ophthalmopathy

Case contributed by Dr Dijendra Nath Biswas

Presentation

Complaining of diplopia for the last 6 months. History of hyperthyroidism and neck swelling for two years. FT3 and FT4 were high and TSAb antibody was positive.

Patient Data

Age: 55 years
Gender: Male
MRI

The distance of the anterior eye globes from the inter zygomatic line is approx 27 mm.

The belly of the extraocular muscles mainly the bilateral medial rectus, lateral rectus, and inferior rectus appear thickened and show signal changes with spares of the tendinous insertions.

Fat stranding is seen in the bilateral orbit.

The bilateral optic nerve appears normal.

Case Discussion

This is a case of bilateral proptosis with thickened extraocular muscle belly with spares of the tendinous insertions and orbital fat stranding associated with hyperthyroidism and goiter. Features suggestive of thyroid orbitopathy or Graves ophthalmopathy.

Differential diagnosis:

  1. orbital pseudotumor
  2. ocular myositis
  3. orbital lymphoma
  4. granulomatosis with polyangiitis

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