2. DEFINITION
• PROPTOSIS refers to forward displacement of
the eyeball beyond the orbital margins.
• EXOPTHALMOS is synonymous but used for
the displacement associated with thyroid
disease.
12. • INTERMITENT PROPTOSIS:
Appears and disappears on its own.
Causes: Periodic orbital edema , Orbital Varix
Recurrent Orbital Hemorrhage, Highly vascular tumours
16. INVESTIGATION OF PROPTOSIS
I. CLINICAL EVALUATION
HISTORY: Age of onset
Nature of onset
Duration
Progression
Chronology of orbital signs and symptoms
17. • LOCAL EXAMINATION:
INSPECTION:
a.) differentiate proptosis from pseudoproptosis.
b.) ascertain whether proptosis is unilateral or
bilateral.
c.) note the shape of skull.
d.) to observe whether protosis is axial or eccentric.
18. PALPATION:
It should be carried out for retrodisplacement of
globe to know:
a.) Compressibility of the tumour
b.) For orbital thrill
c.) Any swelling around the eyeball
d.) Regional lymph nodes and orbital rim
19. AUSCULTATION:
Search for abnormal vascular communications that
generate a bruit such as caraticocavernous fistula.
20. • TRANSILLUMINATION:
Helpful in evaluating anterior orbital lesions.
• VISUAL ACUITY:
Orbital lesions reduce visual acuity by-
a.) refractive changes due to pressure on back of
eyeball.
b.) optic nerve compression.
c.) exposure keratopathy
21. • PUPIL REACTIONS :
Presence of Marcus Gunn pupil is suggestive of optic
nerve compression.
• FUNDOSCOPY :
May reveal
venous engorgement ,
hemorrhage
papilloedema
and optic atrophy.
22. • OCULAR MOTILITY:
It is restricted in thyroid opthalmopathy, extensive
tumour growths and neurological deficit.
23. • EXOPTHALMOMETRY :
It measures the protusion of the apex of cornea from
the outer orbital margin (with the eyes looking
straight ahead).
Normal values vary between 10 and 21 mm and are
symmetrical in both eyes.
A difference of more than 2 mm between the two eyes
is considered significant.
24. • The simplest instrument to measure proptosis is
Luedd’s exopthalmometer.
The Hertel’s exopthalmometer is most commonly
used instrument as it measures the two eyes
simultaneously.
25. • SYSTEMIC EXAMINATION :
Rule out systemic causes of proptosis such as
Thyrotoxicosis
Histiocytosis
Primary tumour elsewhere in the body.
Otorhinolaryngological examination is necessary
when the nasopharyngeal mass appears to be a
etiological factor.
26. LAB INVESTIGATIONS
• Hematological studies -TLC , DLC , ESR , VDRL test
• THYROID FUNCTION TESTS
• Casoni’s test (rule out for hydatid cyst)
• Stool examination for cysts and ova
• Urine analysis for Bence Jones proteins for multiple
myeloma
