Recurrent proptosis and thyroid eye disease

A 58-year-old Caucasian woman presented to our hospital with a 2-week history of diplopia and proptosis of the left eye. Ten years earlier, she had been diagnosed as having ophthalmic Graves' disease and subsequently underwent successful left transantral orbital decompression for optic nerve compression. On clinical examination, there was bilateral proptosis, 5 mm greater on the left side, and hypoglobus of the left eye. Her visual acuities and colour vision were normal (Snellen visual acuity: left 6/6, right 6/6). There was significant restriction of ocular movements in the left eye. Routine haematological tests were performed, including thyroid function, which were all normal. A computed tomographic (CT) scan of the orbits was performed (figures 1 to 5). ... The most likely causes are mucocele or recurrent thyroid eye which are specific to this case. Other causes of proptosis include axial causes (orbital varices, caroticocavernous fistulas, optic nerve gliomas, cavernous haemangioma, meningiomas and orbital pseudotumours, eg, lymphoma) and non-axial causes (dermoid cysts in children or young adults, neurofibromatosis in children, lacrimal tumours, mucocele or carcinomas of sinuses (ethmoidal and frontal), meningoencephalocele, and rhabdomyosarcomas in children).