: The authors report the case of a 32-year-old woman who presented with bilateral lower eyelid swelling and extraocular muscle enlargement as the initial manifestation of acromegaly. The acromegaly, however, was not diagnosed until 6 years after her symptoms began. Acromegaly should be entertained in the differential diagnosis of any patient who presents with bilateral, symmetrical extraocular muscle enlargement on computed tomographic scan, especially in the patient with normal thyroid hormone levels and no clinical findings associated with thyroid orbitopathy.
Wegener granulomatosis has a variety of uncommon initial presentations. Although conjunctival involvement in this condition is rare, the diagnosis of Wegener granulomatosis should be suspected when the conjunctival inflammation is recurrent and not typical of other conjunctival inflammatory conditions.
We describe a case of a 32-year-old man who presented with a visually apparent but otherwise asymptomatic mass in the right lateral fornix. Computerized tomography demonstrated the mass adjacent to the lacrimal gland. The mass was surgically removed, and histopathologic examination was consistent with a dacryolith of the lacrimal ductule. There were several cilia isolated from the dacryolith. This entity should be considered in the differential diagnosis of patients presenting with a localized mass in the region of the lacrimal gland.
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