A 55-year-old obese woman was first examined in March 2006 complaining of diplopia and unilateral exophthalmos in the left eye (). She reported a 2.5-year long history of TAO in the context of Graves disease, poorly responsive to intravenous methylprednisolone regimens.\nShe returned 3 years later with a recent onset of symptoms in the previously not involved right eye. She was particularly concerned about the emergence of a soft “lump” in the outer part of the recently involved right eye. Exophthalmos, eyelid retraction and the presence of a soft lump under the eyelid protruding above the lateral canthus were noted in the right eye (). The lesion was soft upon palpation and persisted unchanged after a 7-month follow-up time despite gradual stabilization of thyroid levels. An orbit MRI showed orbital fat prolapsing anteriorly, anterior bowing of the orbital septum and lateral displacement of the lacrimal gland which looked smaller in the involved orbit as opposed to normal size and appearance of the lacrimal gland in the contralateral left orbit ().
A 71-year-old man presented in November 2007 complaining of a “mass” like protrusion under the lateral part of both upper eyelids for the last several months (). He had previously undergone orbit decompression and strabismus surgery in both eyes elsewhere for TAO diagnosed 5 years before, confirmed with past orbit MRI scans. The lesion had a light purple-yellow hue () and was soft and non tender upon palpation.