A 68-year-old male presented in May 2006 complaining of a visible “mass” protruding under the lateral part of his mildly swollen right upper eyelid and intermittent diplopia.\nThe “mass” had a yellowish purple hue and was soft and non tender upon palpation. Upper eyelid retraction and restriction of elevation was noted in the right eye (). A systemic work-up for autoimmune dysthyroidism revealed euthyroid status and borderline elevation of anti-TSH receptor antibodies: 8.8 (nl <9, sensitivity 0.8). The diagnosis of euthyroid Graves orbitopathy was established based on the typical constellation of ipsilateral proptosis, eyelid retraction, lid and conjunctival edema as well as tendon sparing enlargement of right inferior and medial rectus muscles. An orbit MRI outlined anterior herniation of intraorbital fat () with slight displacement of the lacrimal gland temporally in the involved right orbit as opposed to normal appearance of the lacrimal gland on the left side.\nHe was treated with intravenous and oral steroids with partial resolution of exophthalmos and diplopia. The prolapse did not cause any symptoms and remained unchanged after 44 months of follow-up time.
A 72-year-old man presented in October 2008 complaining of a yellowish bulge protruding under the upper eyelid of both eyes for the past 6 months and a gradually worsening “swelling” of his eyes. Clinical and paraclinical testing revealed hyperthyroidism and signs of Graves orbitopathy. An orbit MRI revealed excess orbital fat herniating anteriorly (). The lacrimal gland on either side was identified in place and was of normal size. He was followed for 15 months, during that time thyroid levels stabilized, without an improvement in the size of the lesion.