—Dr Newman's comments seem reasonable and valid. In cases of orbital disease with extraocular muscle enlargement, a further search for evidence of orbital neoplasia is indicated only in the presence of features that are atypical for a benign process. Certainly, when the findings are pathognomonic for Graves' orbitopathy, and the diagnosis is straightforward, further investigation is not warranted. In the present case, the orbital CT scan was misinterpreted as showing bilateral extraocular muscle abnormalities by a neuroradiologist, a neurosurgeon, an endocrinologist, and an otolaryngologist. Prior to surgical treatment, the patient also received a concurring opinion from a second orbital surgeon at a major university center. The full series of CT sections could not be reproduced for the brief case report. Based on the CT scans, most of the observers believed that each medial rectus muscle was enlarged and that this was probably the case for each inferior rectus
Reifler DM. Sphenoid Ridge Meningioma Masquerading as Graves' Orbitopathy-Reply. Arch Ophthalmol. 1987;105(8):1018. doi:10.1001/archopht.1987.01060080015006
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