Purpose: To describe a thyroid orbitopathy patient who had asymmetric progression of exophthalmos due to orbital varicose vein.

Patient: A 55-year-old patient with thyroid orbitopathy had asymmetric progression of exophthalmos without complaints over 4 years of follow-up.

Results: In repeated computerized tomography (CT) of the orbit, a dilation of the superior ophthalmic vein was noted on the more proptotic eye, in addition to bilateral excessive orbital fat. This finding was also confirmed on color Doppler imaging in valsalva manoeuver.

Conclusions: In patients with thyroid orbitopathy who have atypical progression course of their exophthalmos, repeated orbital CT scan is advocated to rule out other concurrent orbital disorders such as varicose veins.

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