low magnification (left photo)
high magnification (right photo)
An otherwise healthy 55-year-old male presented with a history of 18 months of tearing in the right eye and progressive periocular swelling on the right, superotemporally, near his brow. There was no eye pain, vision loss, or diplopia. Examination revealed best corrected visual acuity of 20/20 in both eyes with normal intraocular pressure, motility and pupils. External exam showed proptosis and hypoglobus on the right, and an elevated right upper eyelid crease. Hertel exophthalmometer measurements were 23mm on the right and 18mm on the left. Slit lamp exam was notable for mild conjunctival injection on the right but was otherwise normal and dilated fundus exam was normal.