Indian Journal of Clinical and Experimental Ophthalmology 2020;6(1):151–154 Content available at: iponlinejournal.com Indian Journal of Clinical and Experimental Ophthalmology Journal homepage: www.innovativepublication.com Case Report Bilateral lacrimal gland enlargement in a patient with thyroid orbitopathy Nagalakshmi Narayana-swamy 1, *, Alhaj Farhath Tasneem 1 1 Dept. of Ophthalmology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India ARTICLE INFO Article history: Received 18-11-2019 Accepted 11-12-2019 Available online 17-03-2020 Keywords: Lacrimal Gland Orbit Thyroid Orbitopathy ABSTRACT Purpose: Thyroid Orbitopathy is a condition associated with thyroid dysfunction. In addition to exophthalmos, eyelid retraction, eyelid oedema, restrictive extra-ocular myopathy, lacrimal gland enlargement can also be observed in these patients. However thyroid orbitopathy is not usually been considered in the differential diagnosis of cases of isolated lacrimal gland enlargement. Materials and Methods: An elderly male patient at our institution presented with bilateral lacrimal gland enlargement as the clinical or radiologic sign and was later diagnosed as thyroid orbitopathy. Computerized tomography and/or magnetic resonance imaging of the orbits were obtained and demonstrated isolated lacrimal gland enlargement with enlargement of lateral rectus and inferior rectus. Result: A case of bilateral lacrimal gland enlargement found in a patient with thyroid orbitopathy was noted. Patient was investigated and kept on follow up. Conclusion: This case represents, enlargement of lacrimal gland as a presenting sign of thyroid orbitopathy. Further clinical and radiological studies are essential for a better understanding of the timing of lacrimal gland involvement. In such patients presenting with lacrimal gland enlargement, thyroid orbitopathy should be strongly considere d in the differential diagnosis in addition to causes such as of dacryo-adenitis and neoplasms. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/) 1. Introduction Thyroid Orbitopathy is the most common cause of proptosis and orbital inflammation in adults. Thyroid orbitopathy is characterized by inflammation, congestion, hypertrophy, fat and orbital muscles fibrosis leading to increase in volume of the muscles. 1 The signs and symptoms present within one year of the onset of the disease and extra-ocular muscles are involved as an immunological phenomenon and present with increase in volume. 2 Characteristic ocular signs include exophthalmos, eyelid retraction, eyelid oedema, restrictive extra -ocular myopathy, and optic neuropathy associated with thyroid dysfunction. The lacrimal gland can be affected in thyroid orbitopathy, though not commonly considered as a primary sign. 3–5 We * Corresponding author. E-mail address: anushkanarayan5@gmail.com (N. Narayana-swamy). present a case of thyroid orbitopathy where bilateral lacrimal gland enlargement detected on imaging studies was the predominate clinical sign in addition to other features of lacrimal gland enlargement. 2. Case Report A 65-year-old male presented with complaints of swelling and protrusion of left eye (Figures 1 and 2) since 4 years. Patient has been treated in an institution outside with oral steroids and found no remission. He was a known case of hypertension on treatment and no other comorbidities. On examination visual acuity in right eye was 6/36 and 6/18 in left eye with normal near vision. Colour vision was normal in both eyes. External exam showed upper eyelid fullness of right eye more than left eye and left side proptosis of 4 millimetre. Motility testing demonstrated a mild elevation deficit of the right eye and a 3 prism dioptre left Hypotropia. There was https://doi.org/10.18231/j.ijceo.2020.033 2395-1443/© 2020 Innovative Publication, All rights reserved. 151