Causes of proptosis

Causes of Proptosis

Causes of ProptosisBy Peter C Roy 2009 batch

Forward displacement of eyeball beyond the orbital margins.

Exophthalmos is synonymous, but is usually used for the displacement associated with thyroid disease.

ClassificationUnilateral Proptosis

Bilateral Proptosis

Acute Proptosis

Intermittebt Proptosis

Pulsation Proptosis

Unilateral ProptosisCongenital:Dermoid cystCongenital cystic eyeballOrbital teratomaTraumatic: Orbital haemorrhageRetained intraorbital Foreign BodyTraumatic aneurysmEmphysema of orbit

Inflammatory Lesions Acute:Orbital cellulitisAbscessPanophthalmitisThrombophlebitisCavernous sinus thrombosisChronic:PseudotumoursTuberculomaGummaSarcoidosis

Circulatory disturbances and vascular lesions:Angioneurotic edemaOrbital varixAneurysmsCysts of orbitHematic cystImplantation cystParasitic cystTumors: primary, secondary, metastaticMucoceles of frontal, ethmoidal, maxillary sinuses

Orbitopalpebral cyst

Preseptal cellulitis

Pseudotumours of right orbit

Bilateral ProptosisDevelopmental anomalies of skullCraniofacial dysostosis eg. Oxycephaly (tower skull)OsteopathiesOsteitis deformansRicketsAcromegaly. Inflammatory conditionMikuliczs syndrome (enlarged lacrimal and parotid glands caused by infiltration with lymphocytes)Late stage of cavernous sinus thrombosis.

Endocrinal exophthalmosThyrotoxic or thyrotropic.Tumours Symmetrical lymphoma orLymphosarcomaSecondaries from NeuroblastomaEwings sarcomaLeukemic infiltration.Systemic diseasesHistiocytosisSystemic AmyloidosisWegeners Granulomatosis

Graves ophthalmopathy with bilateral exophthalmos and lid retraction

Oxycephaly

Acute ProptosisDevelops with extremely sudden onset

Common causes are Orbital emphysemaFracture of medial orbital wallOrbital hemorrhageRupture of ethmoidal mucocele

Intermittent Proptosis Appears and disappears on its own.

Common causes arePeriodic orbital oedemaOrbital varixReccurent orbital haemorrhageHighly vascular tumours

Pulsating Proptosis Causes: Pulsating vascular lesions like Caroticocavernous fistula and saccular aneurysms of ophthalmic artery.

Also by transmitted cerebral pulsations associated with deficiency of orbital roof. These include congenital meningocele or meningoencephalocele, neurofibromatosis, traumatic or operative hiatus

PseudoproptosisOne eye may look to be larger than the other eye

CausesUnilateral high axial myopiaUnilateral buphthalmosPseudocornea or anterior staphylomaRetraction of eyelid of one eyeEnophthalmos of opposite eye

Pseudocornea RE

Myopia RE

Buphthalmos LE

InvestigationsLocal ExaminationInspection - to diff proptosis and pseudoproptosis, if proptosis is unilateral or bilateral, to note the shape of the skullPalpation swellings, regional lymph nodes, orbital rimAuscultation to know abnormal vascular communications like caroticocavernous fistulaTransilluminationVisual acuity may decrease due to pressure in the back of the eyeball, optic nerve compression, exposure keratopathy

Pupil reactionsFundoscopy venous engorgement, hemorrage, disc edemaOccular motility decreased in thyroid ophthalmopathyExophthalmometry Measures the protrusion of the apex of the cornea from the from outer orbital marginNormal 10 to 21 mm, symmetrical in both eyesDifference of more than 2 mm is significant

Lueddes Exophthalmometer

Hertels Exophthalmometer (can measure both eyes simultaneously)

Systemic ExaminationLaboratory investigations thyroid function test haematological studies Casonis test Stool examination for ova and cysts Urine analysis for bence jones proteinsImaging techniquesNon-invasive Plain X rays, Compted tomography scanning, Ultrasonography, MRIInvasive Not done

Histopathological studiesFine needle aspiration biopsyIncisional biopsyExcitional biopsy

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