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 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.