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 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.