Graves ophthalmopathy

Case contributed by Dr Shervin Sharifkashani

Presentation

Pronounced bilateral proptosis and preseptal soft tissue swelling and orbital pain with a history of long-standing graves disease.

Patient Data

Age: 65 years
Gender: Male
CT

Bilateral pronounced proptosis, enlargement of all extraocular muscles containing hypodense foci, enlarged and prolapsed lacrimal glands, and remodeling of orbital medial walls due to enlarged medial rectus muscles on both sides are seen. Crowding of the apex of orbits is noted. Enlarged orbital fat with bulging within eyelids is seen. Preseptal soft tissue swelling more in lower eyelid is also noted.

Case Discussion

The case illustrates a relatively rare enlargement of all extraocular muscles containing hypodense foci on both sides of orbital cavities in Graves disease. The hypodense foci in extraocular muscles are usually due to mucopolysaccharides accumulation. 

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