Graves’ Disease

A 34-year-old Indonesian man had a 2-year history of prominence, redness, and irritation of his right eye. He had been treated with prednisone during this time with doses varying from 80 mg a day initially to 20 mg when the process seemed less severe. He had not been evaluated for osteoporosis, ulcers of the stomach, tuberculosis, or diabetes during this time. He had a striking Cushinoid appearance to his facies. Ocular examination showed exophthalmometry measurements of 25 mm OD and 21 mm OS. There was moderate conjunctival injection and chemosis of the right eye. His vision was 20/40 OD and 20/25 OS with a 2+ posterior subcapsular cataract noted on the right. Intraocular pressure measured 21 mm OD and 20 mm OS. Fundus examination showed a cup to disc ratio of 5/10 OD and 4/10 OS. Various ophthalmology residents had followed him in the clinic over the 2-year period with the diagnosis of orbital pseudotumor. A plain film skull x-ray had been obtained at one time that was interpreted as normal by the radiologist.