Thyroid Eye Disease (2)
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I show this case as an excellent example of how thyroid
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eye disease or thyroid orbitopathy
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can cause unilateral proptosis.
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Here we have a patient who has left
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sided exophthalmos or proptosis.
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This is also an excellent example of how you
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can have involvement of the muscle belly
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with sparing of the tendinous insertion of the muscle.
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This patient also has lacrimal gland which
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is anteriorly located within the orbit.
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Let's scroll through this a little bit more.
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You can see that the patient has marked enlargement of
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the superior rectus muscle on the left
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side compared to the right side.
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We have increased orbital fat on the left side compared
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to the right side. But note, however,
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that the optic nerve at the optic canal and orbital
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apex still has fat on either side of it,
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and therefore this patient would not necessarily need
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orbital decompression for thyroid eye disease.
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The inferior rectus muscle is markedly enlarged
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on the left side compared to the right side.
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So unilateral exophthalmos associated with thyroid
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orbitopathy without compression of the optic nerve,
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but with demonstration of the lacrimal
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gland being protruded anteriorly.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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