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ProptosisMounir Bashour, M.D., C.M.
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What is proptosis? Forward protrusion of one or both
eyeballs
Unilateral asymmetric protrusion ofone eye by at least 2 mm
Normal upper limits
22 mm in Caucasians 24 mm in African-Americans
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Howis proptosisdiagnosed? lobes from abo!e
"easured with an e#ophthalmometer
lateral orbital rim C$ scan
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List commonproblems associatedwith proptosis 1. Exposure keratopathy
poor blin% mechanism
corneal abrasions and ulcers
2. Diplopia displacement of the globes
e#traocular muscle function
3. Optic nere compression
decreased !isual acuity
&A'(
color !ision deficit
!isual field defect
prompt therapeutic inter!ention
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!ost common causeo" unilateralproptosis? $hyroid eye disease )ra!es*
ophthalmopathy+
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!ost common causeo" bilateral proptosis?
$hyroid eye disease
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What are other causeso" proptosis? ,rbital inflammatory pseudotumor
,rbital infectious cellulitis
,rbital tumors )benign or malignant+
acrimal gland tumors
$rauma )retrobulbar hemorrhage+
,rbital !asculitis )i.e./ polyartentts nodosa/
0egener*s granulomatosis+
"ucormycosis
Carotid-ca!ernous fistula
,rbital !ari#
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List the causes o"pseudoproptosis 1. Unilateral high a#ial myopia
A-can
2. Actual enophthalmos of other eye 3. Upper lid retraction
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Which neuroima#in#test is best to ealuatethe etiolo#y o"
proptosis?
$% scans are superior in most cases
!&' may be desirable in certain caseswhen optic ner!e dysfunction is
present
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(nilateral or bilateralpainless proptosis) eyelidretraction) eyelid la#) andmotility disturbances? $hyroid ophthalmopathy
multisystem. autoimmune disorder
hyperthyroid/ hypothyroid/ euthyroid
inflammation and enlargement ,"
5 6&7"&7&7&
5 fusiform enlargement sparing the tendon
peribulbar tissues.
'roptosis
yelid retraction
Corneal problems
(iplopia
,ptic ner!e compression
$reatment depending on the se!erity
ystemic and laboratory e!aluation is mandatory
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(nilateral proptosis) pain)
con*unctial in*ection) andmotility disturbances in anadult? ,rbital inflammatory pseudotumor
nonspecific idiopathic inflammatory
locali8ed to muscle/ lacrimal gland/ sclera !s. diffuse
eyelid erythema or edema
palpable mass decreased !ision
u!eitis
hyperopic shift
optic ner!e edema
9ilateral disease more common in children
C$ scan thic%ening 1: ," )inc. tendons+
lacrimal gland enlargement
thic%ening of the posterior sclera
$reatment corticosteroids :;- radiation
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(nilateral proptosis) pain)
"eer) decreased ocularmotility) erythema) andedema o" the eyelids? 6nfectious orbital cellulitis
usually bacterial
e#tended posterior to orbital septum
meningitis
ca!ernous sinus thrombosis
staphylococci. streptococci. anaerobes/ and
Haemophilus influenza )in children under salmon-colored mass in the forni# C$ scan
poorly defined mass conforming to the shape of the
orbital bones and globe without bony erosion
orbital biopsy
definiti!e treatment is radiation
associated with systemic lymphomaD therefore
medical consult and systemic e!aluation are
necessary for all patients
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%umors that are
encapsulated or appearwell circumscribed onneuroima#in# Ca!ernous hemangioma chwannoma
Fibrohistiocytoma Neurofibroma
Hemangiopericytoma