Table 1.
Reported cases of unilateral proptosis in GO.
| Articles | Age (years)/gender | Clinical features | Laboratory findings | Imaging findings | Treatment | Outcomes | |
|---|---|---|---|---|---|---|---|
| History | Examination | ||||||
| Michigishi et al. 14 | 39/Female | Left painless proptosis with retraction of upper eyelid | Hard nodule on the right thyroid lobe, Hertel exophthalmometer showed 25 and 18 mm in the left and right eyes, respectively | Normal thyroid function tests; thyroglobulin and TRAb elevated | Enlargement of the left eye muscles without swelling of their tendons in MRI | IV methylprednisolone; subtotal thyroidectomy | Full recovery |
| Arslan et al. 2 | 43/Male | Decreased vision in the right eye after eyelid swelling, burning, and stinging; chemosis; optic neuropathy; and smoker | Hertel exophthalmometer showed 21 and 18 mm in the right and left eyes, respectively | Normal thyroid function tests; Anti-thyroglobulin and anti-peroxidase antibodies negative; TRAb positive; suggest euthyroid GD | Mild enlargement of all EOMs of the right eye without the involvement of the tendons in MRI | Methylprednisolone | Fully recovered; restoration of normal visual acuity and visual field in the right eye |
| Locarzona et al. 15 | 62/Female | Progressive exophthalmos, dilated and tortuous conjunctival blood vessels (corkscrew hyperemia), and chemosis in the right eye | Visual acuity = 20/20 in each eye; asymmetry in the IOP, not increasing in up gaze (Bradley maneuver); normal extraocular motility and fundoscopy | Normal thyroid function; anti-thyroglobulin; and anti-peroxidase positive | Early and abnormal filling of the CS and an enlarged superior ophthalmic vein in neuroimaging suggesting a CCF | Interventional treatment | Recovered with no recurrence |
| Rubinstein 12 | 50/Female | Eye irritation, tearing, visual changes, orbital pain, and proptosis (left more than right) | Hertel exophthalmometer measurements were 20.5 OD, 22.5 OS, base 96 | Normal thyroid function test; Elevated thyroid-stimulating immunoglobulin | Enlarged inferior and medial recti muscles (left more than right) without tendon involvement in CT | IV teprotumumab | Partial reduction in proptosis |
| Macovei and Azis 16 | 52/Male | Exophthalmos, eyelid retraction, corneal ulceration, chemosis, pannus formation in the left eye progressing to the right eye, decrease in visual acuity of the right eye, and blurred vision; smoker | Low-grade orbital pain on palpation, normal right eye in fundoscopy | Hyperthyroidism with high levels of FT3, FT4, and low TSH; high levels of TSH-R autoantibodies | Enhancement of the EOM sheaths and stranding of surrounding orbital fat on orbital imaging | IV methylprednisolone; topical broad-spectrum antibiotics; topical combination of timolol and dorzolamide; thyrozol and propranolol | Poor recovery due to delayed surgery: improvement of exophthalmos but decreased visual acuity in right eye due to cataract; drug-induced hypothyroidism |
| Stephen et al. 17 | 32/Female | Protrusion of the right eye, orbital pain, and double vision; | Visual acuity in both eyes = 6/6, exophthalmometer reading of 24 mm in the right eye and 20 mm in the left eye measured at 100 mm | Hyperthyroidism; features of PNET (MIC-2 gene positive) on biopsy and immunohistochemistry | The irregular mass lesion in the right orbit without bone erosion in CT; bulkiness in all 4-rectus muscles | En bloc excision of the lesion | Complaints gradually subsided with only minimal eye pain and no diplopia |
| Our case | 25/Female | Proptosis of the right eye; no visual difficulty; weight loss, menstrual irregularities, and occasional palpitations; nonsmoker | Visual acuity in both eyes = 6/6; clinical severity score 3/7; hertel exophthalmometer reading of 23 mm in the right eye and 21 mm in the left eye | Hyperthyroidism with high levels of FT3, FT4, and low TSH; TRAb positive; normal liver and renal function tests | Unilateral EOM enlargement and enhancement with tendon sparing and relative right proptosis on MRI of orbit | IV methylprednisolone, methimazole | Full recovery |
TSH: Thyroid stimulating hormone;TSH-R: Thyroid stimulating hormone receptor; TRAb: Thyroid stimulating hormone receptor antibody; MRI: magnetic resonance imaging; GD: Graves’ disease; GO: Graves’ ophthalmopathy; TED: thyroid eye disease; EOM: extraocular muscle; CS: cavernous sinus; IOP: intraocular pressures; CCF: carotid cavernous fistula; CT: computerized tomography; PNET: primitive neuroectodermal tumor, OD: oculus dexter (right eye); OS: oculus sinister (left eye); IV: intravenous.