The Syndrome de Means is a clinical entity that represents a form of thyroid-related ophthalmopathy characterized by the dissociation between orbital involvement and thyroid disease expression. It is defined as a type of thyroid ophthalmopathy that
does not exhibit any clinical or biological signs of thyroid dysfunction. This syndrome accounts for 8% to 21% of cases of ophthalmopathy associated with thyroid diseases, emphasizing the evolutionary dissociation between orbital pathology and
the subsequent clinical and/or biological expression of thyroid disease . We report the case of a38-year-old male patient with no previous medical history presented with bilateral exophthalmos, ptosis and diplopia with limited ocular motility that had been present for 8 months. Ophthalmologic examination revealed corrected visual acuity was 7/10 (right eye) , 8/10 (left eye), and he had bilateral, axial, non-pulsatile exophthalmos that was reducible and not very painful, with limited ocular motility in
all 9 visual positions , The rest of the ophthalmologic examination, including the fundus, was normal . The patient was clinically euthyroid, with no goitre on neck examination and no signs of inflammation. Thyroid function tests were ordered (TSH
0.55 mUI/L, free T4 18.56, Anti-TPO 41.3 UI/ml).An MRI of the orbit was ordered, which showed stage II exophthalmos in the right eye and stage I in the left eye, with fusiform swelling of the right orbital muscles and the right outer muscle of the
left orbit .The patient received an injectable corticosteroid for 3 days, which resulted in a slight clinical improvement.