Globe subluxation in thyroid orbitopathy

We report the clinical and radiographic findings of a female patient who presented to the emergency room in acute distress due to a subluxated globe. The patient had a 10 year history of poorly controlled Grave's disease and associated orbitopathy. In the past, one previous report dealt with this rare phenomenon in association with Grave's disease and attributed the mechanism of this acute event to enlargement of the orbital fat compartment and extensibility of nearly normal extraocular muscles ("lipogenic" - type I orbitopathy). To the best of our knowledge, this case is the first documented report of this unusual event occurring in a patient with significant involvement of the extraocular muscles which caused a resultant crowding of the orbital apex, disturbance to venous outflow and severe orbital congestion. In conclusion, acute globe subluxation may rarely happen in "myogenic" (type II) thyroid orbitopathy.