Thyroid associated orbitopathy

Case contributed by Dr Ian Bickle


Graves disease, worsening vision.

Patient Data

Age: 40 years
Gender: Female
Race: Asian

Bilateral proptosis and enlargement of multiple rectus muscles. Crowding, but not compression of the optic nerve, at the orbital apex.

Annotated image

Illustration of how the term 'coca cola bottle' sign arises.  (Courtesy of Matt Skalski).


Marked enlargement of the inferior, medial and superior rectus muscles, with sparing of the tendinous insertions, giving a Coca-Cola bottle appearance.

Case Discussion

Bilateral proptosis due to thyroid associated orbitopathy.  The enlargement of the muscles in this case follow the mnemonic I'M SLOW, which is typically the case.

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Case information

rID: 24315
Published: 7th Aug 2013
Last edited: 22nd May 2020
Inclusion in quiz mode: Included

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