Image Challenge

A 67-year-old man presented with a 1-year history of bilateral eye swelling and right eye protrusion and a 2-week history of blurry vision. There was no swelling of the parotid or submandibular glands. MRI of the orbits showed bilateral lacrimal gland and lateral rectus muscle swelling as well as mass lesions surrounding the optic nerves. He was initiated on daily prednisone with improvement in his symptoms. What is the diagnosis?

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