Ali and colleagues report the case of a 54-year-old female who presented with thyrotoxicosis and signs of Graves’ orbitopathy affecting her right eye (clinical activity score 4/10). She had a prosthetic left eye, as a consequence of previous trauma. Shortly after presentation, she noticed altered position of her prosthesis, with the eye tilting upwards. Magnetic resonance imaging (MRI) demonstrated swelling of inferior and medial recti muscles bilaterally.

This case is, therefore, an important reminder that Graves’ orbitopathy is a condition that affects the tissues of the orbit, rather than the eyeball itself. It shows the value of MRI scanning in the assessment of Graves’ orbitopathy.

The patient received treatment with rituximab, after refusing glucocorticoid therapy because of concerns about side effects. She also required oculoplastic intervention (botulinum toxin to upper eyelid, plus blepharotomy surgeries) to limit the effects of corneal exposure in her right eye. A euthyroid state was achieved and maintained with a block-and-replace treatment regimen.

Read the full article in Endocrinology, Diabetes & Metabolism Case Reports doi:10.1530/EDM-22-0341