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JAMA Ophthalmology Clinical Challenge |

Intractable Graves Ophthalmopathy?—Diagnosis

JAMA Ophthalmol. 2013;131(2):270. doi:10.1001/jamaophthalmol.2013.2264b.
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Correspondence: Francisco Castillo, MD, Ophthalmology Department at Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905 (castillo.francisco@mayo.edu).

Submitted for Publication: November 14, 2012; accepted December 2, 2012.

Conflict of Interest Disclosures: None reported.

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Figure 1. Proptosis and conjunctival hyperemia with no evidence of upper eyelid retraction or eyelid lag.

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Figure 2. Coronal and axial computed tomography. A, Coronal computed tomography shows enlargement of both the lateral rectus and inferior rectus muscles and minimal enlargement of the superior rectus (left > right) and left superior oblique muscles. The lateral rectus enlargement is out of proportion to the other muscles. The infraorbital nerves are markedly enlarged (arrows). B, Axial computed tomography shows massive enlargement of each lateral rectus muscle, which is enlarged out of proportion to the medial rectus muscle enlargement.




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