Usually, the degree of asymmetry between the orbits is not as pronouced as in this patient. Inflammatory orbital pseudotumor can cause enlargement of the muscle, but the tendinous portion is classically affected by the inflammation, in contrast to thyroid disease where the tendinous portion is spared. Rarely, neoplastic lesions may infiltrate the muscles. Amyloidosis may also enlarge the muscles through an infiltrative process. Compressive optic neuropathy from muscle enlargement and corneal exposure leading to ulceration and perforation.
Treatment is dependent on the severity of the disease.
If mild, the patient may be treated with topical lubrication and patching at night. If in the acute inflammatory phase, the patient may require systemic corticosteroids or immunosuppressive agents. Lid surgery may be necessary to repair lid retraction. Orbital decompressive surgery is an effective treatment for compressive optic neuropathy. Traditionally this was done by removing the medial orbital wall along with the orbital floor.