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 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 ().