HN is an 80-year-old male who presented with rapidly progressive proptosis and reduced vision over the period of a month. He gave a long history of smoking and no past history of thyroid disease. Examination found visual acuity OD of 20/100 and OS of 20/200. Intraocular pressures were 23 mm in the right eye and 24 mm in the left. Hertel exophthalmometry measured 22 OD and 23 mm OS. He had moderate lid edema and conjunctival chemosis. Slit-lamp examination showed mild corneal epithelial stippling bilaterally with poor tear film coverage. Fundus examination was unremarkable except for age-related macular drusen and retinal pigment epithelial changes. Visual field testing showed moderate peripheral depression.
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