Bilateral inferior oblique enlargement in thyroid eye disease.

Extraocular muscle enlargement is a hallmark of thyroid eye disease (TED), typically affecting the rectus muscles. We report a rare case of asymmetrical bilateral inferior oblique enlargement in a patient with probable TED. Although TED is the commonest cause of extraocular muscle enlargement, involvement of the inferior oblique muscle is extremely rare, and all such cases should be investigated for other non-TED etiologies, including inflammatory or neoplastic lesions.