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Findings

Diffuse enlargement of the medial and inferior rectus muscles

Increased enhancement of the medial and inferior rectus compared to the other EOM.

Relative sparing of the myo-tendonous junction

Increased orbital fat

Globes are proptotic

Findings are bilateral and symmetric

Differential Diagnosis

Thyroid Associated Orbitopathy

Orbital Pseudotumor

Sarcoidosis

Lymphoma

Infectious cellulitis/myositis

Metastatic disease

Thyroid Associated Orbitopathy

Clinical presentation

Orbital edema, proptosis, and restricted gaze

Most common cause of protosis in adults

Typical patient is middle-aged female (M:F, 3-6:1)

More severe and later onset in men

Natural History

Usually self limited with favorable outcome

Significant chronic orbitopathy in 10-15%, severe in 5-6%

Coexistent with systemic thyroid disease

TAO onset prior to thyroid disease in 20%, coincident in 40%, andn afterwards in 40%

Treatment

Supportive therapy for early and mild cases

Medical therapy

Corticosteroids, immunosuppresive drugs

Radiation therapy for rapid palliation

Surgical decompression

Harnesberger, HR: Diagnostic Imaging-Head and Neck. Salt Lake City, 2004, Amirsys Inc.