Proptosis

ByDr Christina Samuel

Postgraduate OphthalmologyMMCH& RI

Forward protrusion of one or both eyeballs.

Unilateral asymmetric protrusion of one eye by at least 2 mm.

Globes from above

Measured with an exophthalmometer

CT scan

1. Exposure keratopathy

2. Diplopia

3. Optic nerve compression

BILATERAL PROPTOSIS:BILATERAL PROPTOSIS:

SEEN MOST COMMONLY IN THROID EYE DISEASE.SEEN MOST COMMONLY IN THROID EYE DISEASE.

Orbital inflammatory pseudotumor Orbital infectious cellulitis Orbital tumors (benign or malignant) Lacrimal gland tumors Trauma (retrobulbar hemorrhage) Orbital vasculitis (i.e., polyartentts nodosa, Wegener's

granulomatosis) Mucormycosis Carotid-cavernous fistula Orbital varix

Thyroid ophthalmopathy◦ multisystem. autoimmune disorder◦ hyperthyroid, hypothyroid, euthyroid

inflammation and enlargement EOM IR>MR>SR>LR fusiform enlargement sparing the tendon

peribulbar tissues.

◦ Proptosis ◦ Eyelid retraction◦ Corneal problems◦ Diplopia ◦ Optic nerve compression◦ Treatment depending on the severity ◦ Systemic and laboratory evaluation is mandatory

Orbital inflammatory pseudotumor ◦ nonspecific idiopathic inflammatory ◦ localized to muscle, lacrimal gland, sclera vs. diffuse ◦ eyelid erythema or edema◦ palpable mass◦ decreased vision◦ uveitis ◦ hyperopic shift◦ optic nerve edema◦ Bilateral disease more common in children◦ CT scan

thickening 1+ EOM (inc. tendons) lacrimal gland enlargement thickening of the posterior sclera

◦ Treatment corticosteroids +/- radiation

Infectious orbital cellulitis ◦ usually bacterial◦ extended posterior to orbital septum ◦ meningitis ◦ cavernous sinus thrombosis◦ staphylococci. streptococci. anaerobes, and Haemophilus

influenza (in children under 5 years of age)◦ most common source -- ethmoid sinusitis◦ intravenous antibiotics

Orbital subperiosteal abscess CT scan◦ confirm diagnosis ◦ locate the abscess

surgical drainage and continued intravenous antibiotics

Optic nerve glioma (juvenile pilocytic astrocytoma) ◦ slow-growing tumor ◦ Decreased visual acuity with a RAPD◦ CT scan or MRI

“fusiform” enlargement of the ON

◦ associated with NF1 Dx if bilateral◦ Systemic evaluation and genetic counselling for NF is essential

Rhabdomyosarcoma ◦ most common primary orbital malignancy of childhood◦ malignant growth of striated muscle tissue ◦ rapidly progressive mass in the superior orbit with proptosis, globe

displacement, and eyelid swelling◦ average age of presentation is 7 years ◦ Prompt diagnosis with orbitotomy and biopsy is crucial◦ overall mortality is 60% once the disease has extended to orbital bones◦ Current Rx with radiation + chemo have lowered mortality rates to 5 to

10%

Cavernous hemangioma ◦ slow-growing vascular tumor ◦ usually diagnosed in young adulthood to middle age◦ CT scan ◦ intraconal well-defined orbital mass◦ Visual acuity is often not affected. ◦ Treatment observation or surgical excision

Orbital lymphomas ◦ typically superior orbit ◦ slow onset and progression◦ subconjunctival “salmon-colored" mass in the fornix◦ CT scan

poorly defined mass conforming to the shape of the orbital bones and globe without bony erosion

◦ orbital biopsy◦ definitive treatment is radiation◦ associated with systemic lymphoma: therefore medical consult and

systemic evaluation are necessary for all patients

Cavernous hemangioma Schwannoma Fibrohistiocytoma Neurofibroma Hemangiopericytoma