Today, I saw a new patient who is a 46-year-old white female who was diagnosed with Graves’, toxic diffuse goiter, early last year. She had some swelling of the eyes and was originally told she had an allergy; then the same person, after he found out she had Graves’, put her on prednisone. It was unknown what the dose was, but the patient showed me her bottles and it is obvious that she was on 20 mg a day, taken at suppertime. She has now come down from this. She was also on prednisone acetate eye drops. The patient denies any history of any problems except that she became quite depressed and her head felt funny on the steroids. The patient had a history of an ulcer problem in the past, which was treated with diet. The patient allegedly had a positive Mantoux test years ago, but her chest x-rays have always been negative. Today when I saw her, she was 20/80 in the right and 20/40 in the left with her refraction. The lids are markedly swollen, and she has marked inferior ptosis from the sagging lids, the water collection, and the redness. There is marked chemosis of the conjunctivae and thickening of the lids. The patient has full extraocular motility, except she cannot converge. There is marked swelling of the globes on the retropulsion exam. The pressures are 21 and 20 in primary gaze and 30 and 24 in up gaze. The discs are flat. The patient has pseudoexfoliation in the right eye and nuclear sclerotic cataracts in both eyes, right greater than left. I counseled the patient about the treatment of this and offered her radiation therapy along with the proper dose of steroids of 100 mg a day for a week and then taper down from the 100 mg. I will send her to see Dr. Zapata for consultation radiation therapy, and then I think we would see her weekly as we get this problem under control. I did not feel she needed any topical medication, and she definitely does not need surgery now since there is no proptosis at this time. We will see her again in 1 week. I counseled her about the side effects of the high dose of stero