A 72-year-old man presented in November 2008 with pronounced ocular misalignment and a conjunctival protrusion under both upper eyelids. He had been diagnosed with autoimmune hyperthyroidism 8 years before. Orbit MRI showed anterior herniation of orbital fat with the lacrimal gland identified at the normal position and size (). The patient declined strabismus surgery and has been followed for 20 months with no change in the clinical picture.
A 65-year-old woman presented in October 2010 for evaluation of a melanocytic lesion on her right upper eyelid. She reported a long history of hypothyroidism and bilateral exophthalmos, upon remission at the time of presentation. Asymmetric bilateral subconjunctival temporal protrusions were noted () which by history had emerged shortly after the onset of TAO. There was no change in the clinical picture after 5 months’ follow-up time.