2. • PROPTOSIS is defined as forward
protrusion of the eyeball
• Proptosis of more than 21mm or more
than 2mm asymmetry between the two
eyes is abnormal
• EXOPHTHALMOS is specifically used to
describe the proptosis of eyes a/w Thyroid
eye disease
• ENOPHTHALMOS is defined as
retrodisplacement of eye into orbit
3. PSEUDOPROPTOSIS
• It is the false impression of proptosis
• Seen in conditions like
1. Buphthalmos
2. High myopia
3. Contralateral ptosis
4. Contralateral enophthalmos
12. • The patterns of orbital involvement can be divided into four
basic categories.
• INFLAMMATORY EFFECT: inflammation may be either
infectious or noninfectious in nature and is associated with
signs and symptoms of redness, swelling, pain, heat, and
loss of function. There is often a mass effect present.
MASS EFFECT: displacement with or without signs of
involvement of sensory or neuromuscular structure.
Displacement points to the location of the diseases and may
help to characterize its nature.
VASCULAR CHANGE: features suggesting vascular disease
include venous dilation, pulsation, expansion with straining
(Valsalva), and hemorrhage.
INFILTRATIVE CHANGE: infiltrative diseases are usually
associated with evidence of destruction, entrapment, or
both. These include effects on ocular movement or
neurosensory function (e.g., optic neuropathy, pain, or
paresthesia).
13. • Sudden dramatic proptosis in a child with recent
upper resp tract infetion – hemorrhage into a
lymphangioma
• Gaze evoked amaurosis – orbital apex tumor
• Pain a/w short h/o mass in region of lacrimal
gland – adenoid cystic Ca
• Long h/o painless mass – pleomorphic adenoma
• h/o tinnitus – AV shunt
• Proptosis increasing on straining – orbital varix
• Spontaneous unilateral periorbital bruising –
amyloidosis
• Spontaneous B/L bruising - neuroblastoma
14. LOCAL EXAMINATION
• 1) INSPECTION –
• Proptosis or pseudoproptosis
• Unilateral or bilateral
• Axial or eccentric
• 2) PALPATION – size ,shape,surface,margins
consistency , tenderness , compressibility
Thrill /increase with valsalva/ orbital rims /
regional lymph nodes
• 3)AUSCULTATION - bruit
15.
16.
17. • 7) ADNEXA –
• Dilated episcleral vessels – AV shunt
• Optociliary shunt vessels- optic nerve sheath
meningioma
• Salmon patch beneath upper eyelid – orbital
lymphoma
• Eversion of upper lid – waxy yellow infiltrate
with tortuous vessels- amyloid
• S shaped deformity of upper lid – plexiform
neurofibroma
• Lid retraction or lidlag - thyroid ophthalmopathy
18.
19. 4) EOM MOTILITY – decreased in thyroid
orbitopathy,extensive tumor growths and
neurological deficit
5) VISUAL ACUITY – maybe decreased due to
Refractive changes due to pressure on
eyeball
Optic nerve compresssion
Exposure keratopathy
6) PUPIL REACTION – RAPD suggests optic
nerve compression
20. 7) COLOR VISION , VISUAL FIELDS
8)FUNDOSCOPY – may reveal hemorrhages ,
papilloedema , optic atrophy , choroidal folds
21. MEASUREMENT OF PROPTOSIS
• Measured by a group of instruments called
exophthalmometer or proptometer
• All instruments are meant to measure the
distance b/w thw apex of cornea and lateral
wall of orbit
• OPTICAL- Lueddes scale and Hertels
exophthalmometer
• MECHANICAL – Gormaz exophthalmometer
22.
23.
24.
25.
26.
27.
28. SYSTEMIC EXAMINATION
• Thyroid examination
• Primary tumors elsewhere in the body –
CVS/RS/Abdomen/PV/Rectal
• ENT examination
29. LAB INVESTIGATIONS
• Hematological - CBC , ESR, VDRL
• Thyroid function tests
• Serum ANA , c- ANCA , ACE
• BUN , Creatinine
• C-XRAY , Mantoux test
• Casonis test – r/o hydatid cyst
• Stool examination – cysts /ova
• Urine analysis – bence jones proteins - MM
30. IMAGING
• XRAY –
• Calcification/hyperostosis – Meningiomas
• Waters view – blow out fractures
• Rhese view – optic foramen and SOF
• CT- SCAN Size , position and shape of
• USG lesion
• MRI
31. • ORBITAL VENOGRAPHY – Orbital varix
• CAROTID ANGIOGRAPHY – Aneurysms /AV
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