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 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.