Checkpoint inhibitor associated orbital inflammation masquerading as ocular myasthenia gravis and thyroid eye disease

We report a case of a 67-year-old woman who presented with double vision and ptosis with clinical findings consistent with ocular myasthenia gravis and imaging findings consistent with thyroid eye disease in the setting of ipilimumab and nivolumab treatment for metastatic melanoma. Ipilimumuab blocks cytotoxic T-lymphocyte-associated antigen 4 and nivolumab blocks programmed death-1 receptors to promote T-cell-mediated response to tumor. [1,2] However, in so doing, these medications can unleash several forms of autoimmune disease affecting the extraocular muscles including myasthenia gravis and thyroid eye disease-like orbital inflammation. [1,3-5]