Atypical Asymmetric Presentation of Severe Graves’ Orbitopathy

Graves' disease is a self-limiting autoimmune thyroid disorder caused by stimulating antibodies to the thyroid-stimulating hormone receptor. It usually affects middle-aged females in fourth sixth decade of life. distinguished keratopathy, chemosis, proptosis, and eyelid swelling, addition ocular discomfort. A total 3-5% cases present with severe form orbitopathy, which manifests diminution vision, optic nerve compression, neuropathy, exposure keratopathy. We describe case 34-year-old female patient who presented chief complaint rapid deterioration vision over period three months right eye. Ocular examination revealed widened palpebral aperture, elevation intra-ocular pressure (IOP) upgaze, restricted eye movements, signs compression. Findings were confirmed on CT scan orbit. The unusual presentation this was that she had rapid, significant eye, progression proptosis more marked contralateral This underlies importance thoroughly examining for any possible orbital apex syndrome both eyes, not just proptosis. patient, being reluctant decompression, prescribed IV methylprednisolone 1 g consecutive days, reduced her improved vision. acted as temporary measure increase duration surgical window until time undergoes surgery.