Exophthalmos, global luxation, rapid weight gain: differential diagnosis

Exophthalmos is an uncommon finding in the clinical setting; exophthalmos with global luxation is distinctly rare. Although the differential diagnosis of exophthalmos can be extensive, the most common causes are thyroid dysfunction and orbital neoplasia. We recently encountered a patient with exophthalmos and global luxation, the onset of which coincided with a weight gain of 45.5 kg (100 lb). An extensive evaluation failed to show any of the common states associated with either exophthalmos or global luxation. The ocular problems resolved with weight reduction only; the cause of both problems seems to have been the deposition of fat in the orbital fat pads. We found two previous reports of this condition in the older medical literature, with minimal clinical evaluations. Our patient was thoroughly studied to clarify the pathophysiologic characteristics of this unusual clinical appearance, and we reviewed the causes of exophthalmos and global luxation.