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 71-year-old man presented in November 2007 complaining of a “mass” like protrusion under the lateral part of both upper eyelids for the last several months (). He had previously undergone orbit decompression and strabismus surgery in both eyes elsewhere for TAO diagnosed 5 years before, confirmed with past orbit MRI scans. The lesion had a light purple-yellow hue () and was soft and non tender upon palpation.