Spontaneous Orbital Wall Fracture Secondary to Neglected Graves’ Orbitopathy: A Case Report and Review of Current Literature

Spontaneous orbital wall fracture, or bony auto-decompression, is an uncommon manifestation of advanced thyroid eye disease (TED) and results from chronic intraorbital hypertension driven by extraocular muscle hypertrophy. We report a 72-year-old woman with a 10-year history of untreated Graves’ disease who presented with severe right-sided ocular pain, massive proptosis, and corneal melting. Orbital computed tomography demonstrated marked bilateral enlargement of the superior, inferior, and medial rectus muscles and a large spontaneous orbital floor fracture in the left eye with inferior rectus herniation and entrapment, despite no history of trauma. Existing reports consistently indicate that spontaneous orbital wall fractures originate from sustained mechanical pressure on the thin medial or inferior orbital walls in the setting of significant extraocular muscle enlargement. These fractures may present with pain, swelling, or mobility limitation, or may remain asymptomatic and be detected only on imaging.