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August 1987

Sphenoid Ridge Meningioma Masquerading as Graves' Orbitopathy

Author Affiliations

San Francisco

Arch Ophthalmol. 1987;105(8):1017-1018. doi:10.1001/archopht.1987.01060080015005

To the Editor.  —Dr Reifler and colleagues1 presented a case of proptosis, visual field loss, and optic neuropathy but misinterpreted it as one of thyroid orbitopathy.While Graves' disease may present as "unilateral" exophthalmos, most computed tomographic (CT) studies show multiple enlarged muscles in both orbits. In the presented case, there is massive involvement of one muscle and questionable involvement of one or two others in one orbit only.In retrospect, one can imagine that there is significant thickening of the bone in the lateral right orbit, as well as the more subtle signs of bone destruction. Nevertheless, in this day of cost-consciousness, I do not believe that every diagnosis of euthyroid Graves' orbitopathy should be viewed with suspicion. If the CT, magnetic resonance imaging, or ultrasonographic findings of multiple enlarged muscles in both orbits are present, these findings are almost pathognomonic.Only in cases in which the typical