7/21/2019 Proptosis

1/18

Jump to first page

ProptosisMounir Bashour, M.D., C.M.

7/21/2019 Proptosis

2/18

Jump to first page

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

7/21/2019 Proptosis

3/18

Jump to first page

Howis proptosisdiagnosed? lobes from abo!e

"easured with an e#ophthalmometer

lateral orbital rim C$ scan

7/21/2019 Proptosis

4/18

Jump to first page

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

7/21/2019 Proptosis

5/18

Jump to first page

!ost common causeo" unilateralproptosis? $hyroid eye disease )ra!es*

ophthalmopathy+

7/21/2019 Proptosis

6/18

Jump to first page

!ost common causeo" bilateral proptosis?

$hyroid eye disease

7/21/2019 Proptosis

7/18Jump to first page

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#

7/21/2019 Proptosis

8/18Jump to first page

List the causes o"pseudoproptosis 1. Unilateral high a#ial myopia

A-can

2. Actual enophthalmos of other eye 3. Upper lid retraction

7/21/2019 Proptosis

9/18Jump to first page

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

7/21/2019 Proptosis

10/18Jump to first page

(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

7/21/2019 Proptosis

11/18Jump to first page

(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

7/21/2019 Proptosis

12/18Jump to first page

(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

7/21/2019 Proptosis

18/18

Jump to first page

%umors that are

encapsulated or appearwell circumscribed onneuroima#in# Ca!ernous hemangioma chwannoma

Fibrohistiocytoma Neurofibroma

Hemangiopericytoma