PMC10213383_01
(A) Patient's photography (taken with the patient's cellphone) in April 2021 before BNT162b2 mRNA COVID-19 vaccine indicating no obvious sign of clinical thyroid eye disease. (B) Patient's photograph 3 weeks after the second dose of the vaccine indicating exophthalmos, eyelid swelling and upper eyelid retraction. (C) Clinical photograph of the patient at presentation in March 2022, demonstrating bilateral exophthalmos, chemosis, conjunctival injection, upper eyelid retraction, swollen eyelids and caruncles. (D) Patient's photography after third dose of IV methylprednisolone indicating marked improvement of the eye signs with no eyelid and caruncles swelling and chemosis, albeit with mild conjunctival injection.
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His baseline photograph prior to the vaccine is seen in Figure 1A. Three weeks after receiving the second dose of the vaccine, he experienced new-onset bilateral eyes redness, dryness, proptosis and diplopia, which were gradually worsening (Figure 1B). In March 2022, his TED worsened, presenting with bilateral exophthalmos, chemosis, conjunctival injection, swollen eyelids and caruncles (Figure 1C). Congestive eye symptoms and diplopia significantly improved after the third dose of MTP (Figure 1D), with a CAS of 1 out of 10 attributable to mild conjunctival injection.
Coronal MRI of the orbits demonstrating bilateral extraocular muscle enlargement especially the inferior and medial rectus muscles (yellow arrows) consistent with thyroid eye disease.
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He underwent magnetic resonance imaging (MRI) of the orbits which showed bilateral extraocular muscle enlargement, especially of the inferior and medial rectus muscle (Figure 2) and proptosis.