Recommended
More Related Content
Similar to 06. Proptosis by Dr. Ummara Shafiq.pdf
Similar to 06. Proptosis by Dr. Ummara Shafiq.pdf (20)
Recently uploaded
Recently uploaded (20)
06. Proptosis by Dr. Ummara Shafiq.pdf
- 1. Dr. Ummara Shafiq M.B.B.S, M.R.C.S (UK), MS Ophthalmology (King Edward Medical University) Fellow of the International Council of Ophthalmology (FICO) Proptosis Consultant Ophthalmologist National Eye Centre, Lahore (NECL) Zarar Shaheed Trust Hospital, Lahore Shaheen Welfare Hospital, Lahore Assistant Professor, Physical Therapy & Rehab Sciences, Allied Health Sciences, Superior University, Lahore
- 2. Proptosis 2 Dr. Ummara Shafiq • Abnormal protrusion of eyeball. • Exophthalmos? • Same as above but usually used in relation to endocrinopathies such as thyroid related proptosis. • >21 mm or asymmetry of >2 mm between the eyes What is Proptosis?
- 3. Proptosis / Dystopia 3 Dr. Ummara Shafiq • Proptosis > forward displacement of eyeball • Dystopia > displacement of globe in coronal plane (horizontal or vertical). • It may or may not coexist with proptosis or enophthalmos Difference:
- 4. Exorbitism 4 Dr. Ummara Shafiq • Exorbitism is a protrusion of the eyeball due to a decrease in capacity of the orbital cavity, with a normal orbital content volume. • Abnormal skull development may lead to shallow orbits causing protrusion of the eyes and inability to close eyes. • Mostly bilateral e.g: craniosynostosis
- 5. Pseudoproptosis 5 Dr. Ummara Shafiq • It is the false impression of proptosis: 1. Buphthalmos 2. High myopia 3. Contralateral ptosis 4. Contralateral enophthalmos 5. Facial asymmetry
- 6. Pathophysiology 6 Dr. Ummara Shafiq • The basic pathophysiology irrespective of the aetiology is an increase in volume of the orbital content within the fixed bony orbital confines. • The orbit is widest anteriorly and not enclosed so the contents are displaced anteriorly resulting in proptosis.
- 7. Proptosis 7 Dr. Ummara Shafiq • Visual Threatening: exposure keratopathy, compressive optic neuropathy • Life Threatening: malignant tumors. • Cosmetic implications Importance Of Proptosis
- 8. Proptosis 8 Dr. Ummara Shafiq • Primary orbital pathology • Secondary to systemic diseases. V I T A M I N • Vascular: Orbital Varices, carotid cavernous fistula , lymphangioma , haemangiomas , AV fistulas • Inflammatory: Thyroid orbitopathy , orbital inflammatory syndrome/ pseudotumor • Trauma: orbital hemorrhage , fractures • Aneurysm(CYSTIC LESIONS): dermoid cyst, encephlocele , mucocele • Miscellaneous: metastatic Ca. Craniosynostosis • Infection: Orbital Cellulitis , mucormycosis , • Neoplasm: optic nerve glioma, optic nerve sheath meningioma, Leukaemia, lymphoma, rhabdomyosarcoma Causes Of Proptosis
- 9. Proptosis 9 Dr. Ummara Shafiq • Unilateral/bilateral • Acute/intermittent • Pulsating/not • Axial/non-axial Classification Of Proptosis
- 10. Proptosis 1 0 Dr. Ummara Shafiq • History • Examionation (systemic and local) • Invstigation • Treatment plan Clinical Approach
- 11. Proptosis 1 1 Dr. Ummara Shafiq • Onset • duration • progression • Constant or intermittent • Decreased vision early/late • Stationary/progressive • Pain • Double vision • Periorbital neurosensory loss • bruits • symptoms aggravated by crying,coughing,straining, nose blowing • Past h/o : Trauma ,fever , chills ,cancer, thyroid d/s History
- 12. Proptosis 1 2 Dr. Ummara Shafiq • A sudden dramatic proptosis with conjunctival prolapse in a child with recent URTI • Lymphangioma • GAZE-EVOKED AMAUROSIS • May be associated with an orbital apex tumor • Proptosis provoked by straining • Orbital Varices • History of “tinnitus” • Arteriovenous Shunt History
- 13. General Physical Examination 1 3 Dr. Ummara Shafiq • Skin and oropharynx: cutaneous /oral vascular lesions > lymphangioma , café au lait spots>neurofibromatosis • Cranial Nerve Examination: periorbital and corneal sensation • Examination of Chest and Abdomen: systemic malignancy: undiagnosed ca breast • The regional/ generalized lymphadenopathy: lymphoproliferative disorder
- 14. Local Examination 1 4 Dr. Ummara Shafiq • Inspection • Palpation • Auscultation • Tests
- 15. Local Examination 1 5 Dr. Ummara Shafiq INSPECTION: • Examiner looks from above standing behind patient/looks up from below with the patient’s head tilted back 1. Type of proptosis (axial / non-axial),location of mass, visible pulsation, skin changes. 2. Lagophthalmos , conjunctival congestion/ discoloration. 3. examination of the globe and ocular adnexa * Dilated episcleral vessels: arteriovenous shunt. 4. Corneal exposure, change in size with valsalva.
- 16. Local Examination 1 6 Dr. Ummara Shafiq PALPATION: • Size, shape, surface, margins , consistency • Signs of inflammation • Tenderness • Reducibility, motility • Variation with valsalva • resistance to retropulsion , Thrill • Corneal sensation, infraorbital / supraorbital • Any swelling around the eyeball, regional lymph nodes & orbital rim
- 17. Local Examination 1 7 Dr. Ummara Shafiq AUSCULTATION • Abnormal vascular communications -> bruit caroticocavernous fistula • Globe temporal region for bruit with bell
- 18. Local Examination 1 8 Dr. Ummara Shafiq TESTS • Transillumination • Visual acuity • Pupillary reactions • Ocular motility • Forced duction test • Tonometry • Fundoscopy • Exophthalmometry
- 19. Fundus examination 1 9 Dr. Ummara Shafiq • signs of venous engorgement • Hemorrhage • Papilledema • optic atrophy • choroidal folds • Intraocular pressure
- 20. Exophthalmometry 2 0 Dr. Ummara Shafiq • Hertel’s exophthalmometer • Luedde scale • Naugle exophthalmometer • Gormaz exophthalmometer
- 21. Exophthalmometry 2 1 Dr. Ummara Shafiq Hertel’s Exophthalmometer • Used for precise exophthalmos measurements • Ranges from 0 to 35 mm
- 22. Exophthalmometry 2 2 Dr. Ummara Shafiq Luedde Exophthalmometer: • Transparent plastic mm ruler which is thicker than normal • Fastest, easiest and least expensive method for measuring exophthalmos
- 23. Exophthalmometry 2 3 Dr. Ummara Shafiq Naugle Exophthalmometer • Superior and inferior orbital-rim based instrument • Can measures the position of the globe accurately even after lateral orbitotomy
- 24. Exophthalmometry 2 4 Dr. Ummara Shafiq Gormaz Exophthalmometer: • Measure with reference distance between two lateral orbital margins • Require topical anesthesia
- 25. Measurement 2 5 Dr. Ummara Shafiq • The normal range is 12–21 mm. • A difference greater than 2 mm between the eyes is significant. • In children and teenagers mean measurements increase with age • Less than 4 years old (13.2 mm) • 5–8 years old (14.4 mm) • 9–12 years old (15.2 mm) • 13–17 years old (16.2 mm). • Depending upon the configuration of the osseous orbit, a value of 15mm might be pathological whereas 21mm might be normal. Axial Length of the eye affects.
- 26. Investigations 2 6 Dr. Ummara Shafiq Orbital Imaging • X-ray Calcification , hyperostosis , blow out fractures • CECT - initial choice of investigation • MRI - orbital apex , CNS involvement , soft tissue infiltration and RB • USG – to assess internal reflectivity of lesion & calcification in RB • CT/MRI angiography for vascular lesions
- 27. Investigations 2 7 Dr. Ummara Shafiq Orbital Imaging LYMPHANGIOMA CAPILLARY HAEMANGIOMA
- 28. Histopathological Studies 2 8 Dr. Ummara Shafiq • FNAC • Incisional biopsy • Excisional biopsy
- 29. Management 2 9 Dr. Ummara Shafiq Local Management: • Sleep in supine position with head elevated (to reduce pressure symptoms) • Taping of lids at night (prevent corneal exposure) • Prisms in diplopia (conservative) Medical Therapy: • Topical tear substitutes • Systemic diuretics – in vascular lesions • Parenteral antibiotics • Pain killers
- 30. Radiations: 3 0 Dr. Ummara Shafiq • Pseudotumour • Lymphoma • Rhabdomyosarcoma • Meningioma • Thyroid orbitopathy Radio Therapy & Chemo Therapy
- 31. Surgical Options 3 1 Dr. Ummara Shafiq • Orbitotomy • Orbital decompression • Combined ethmoidectomy
- 32. Proptosis In Adults 3 2 Dr. Ummara Shafiq • Thyroid Exophthalmos • Pseudo tumor • Cavernous hemangioma • Carotid-cavernous fistula • Optic nerve sheath meningioma • Summary
- 33. Pseudotumor 3 3 Dr. Ummara Shafiq • Idiopathic orbital inflammatory disease • Non-infectious, non-Neoplastic • May involve any of soft orbital tissue o Muscles o Lacrimal gland o Tenon capsule
- 34. Presentation 3 4 Dr. Ummara Shafiq • Unilateral – adults, may be bilateral – children • 3rd – 6th decade • Acute • Painful • Periorbital swelling • Redness / chemosis • Congestive Proptosis • Ophthalmoplegia • Optic nerve dysfunction • Palpable mass
- 35. Course 3 5 Dr. Ummara Shafiq • Spontaneous remission • Intermittent episodes • Prolonged inflammation – Fibrosis • Frozen orbit 1. – Ophthalmoplegia 2. – Ptosis 3. – Visual impairment
- 36. Treatment 3 6 Dr. Ummara Shafiq • Middle aged (female) • Slowly growing unilateral axial proptosis • Decrease in VA • Diplopia • Rarely gaze evoked amaurosis fugax • May be accelerated by pregnancy
- 37. Signs 3 7 Dr. Ummara Shafiq • Dilated & tortuous epibulbar vessels • Other defects – Color vision • – Visual field • – RAPD • Fundus – Optic disc edema & choroidal folds
- 38. Work-Up 3 8 Dr. Ummara Shafiq • CT – Well circumscribed, round or oval isointense mass – Usually in lateral part of muscle cone • USG – High echogenecity on A-scan. • Reflect septae within the lesion
- 39. Teatment 3 9 Dr. Ummara Shafiq • Surgical En-bloc removal • Approach • Lateral orbitotomy -lateral lesions
- 40. Carotid-cavernous Fistula 4 0 Dr. Ummara Shafiq • An abnormal communication btw cavernous and external or internal carotid arteries • Classification • – Etiology • Traumatic vs. spontaneous • – Hemodynamics • High vs. low velocity • – Anatomy • Direct vs. indirect
- 41. Direct Carotid-cavernous Fistula 4 1 Dr. Ummara Shafiq • 70-90% of all cases • Communication btw intracavernous part of ICA & cavernous sinus • High arterial blood flow • Causes • Spontaneous…25% • Middle aged woman, atherosclerosis, HTN, pregnancy , Collagen vascular disease, Connective tissue disorders • Trauma (basal or facial skull fracture)…75% • Iatrogenic
- 42. Indirect Carotid-cavernous Fistula 4 2 Dr. Ummara Shafiq • Communication btw cavernous sinus & meningeal branches of ICA and/or ECA • Low arterial blood flow • Causes • Spontaneous • Congenital AV-malformations
- 43. Presentation 4 3 Dr. Ummara Shafiq • Days or weeks after head injury • Hx of surgery or systemic factors • Triad 1-Pulsatile proptosis 2-Chemosis 3-Whooshing noise in head • Decreased vision • Diplopia • Epibulbar injection • Ptosis • Pulsatile proptosis with bruit • Increased IOP • Anterior segment ischemia (Corneal edema, Aqueous flare, Iris atrophy, Rubeosis iridis, Cataract)
- 44. Presentation 4 4 Dr. Ummara Shafiq • Exposure keratopathy Ophthalmoplegia • Fundus changes • Optic disc swelling • Venous dilatation • Intraretinal hemorrhages • CRVO • Ischemic optic neuropathy • NVG
- 45. Work-up 4 5 Dr. Ummara Shafiq • CT, MRI & Orbital echo • Enlargement of EOM • Dilation of one or both superior ophthalmic veins • Enlargement of the affected cavernous sinus • Arterial Angiography – Definite diagnosis
- 46. Treatment 4 6 Dr. Ummara Shafiq • Medical • Exposure keratopathy • Glaucoma • NVG • Surgery • Indication – Post traumatic fistula – Failure to spontaneous closure • Procedures • Surgical repair of the damaged portion of the intracavernous internal carotid artery • Electrothrombosis,Embolization, or Balloon occlusion of the fistula
- 47. Optic Nerve Sheath Meningioma 47 Dr. Ummara Shafiq • Arise from meningiothelial cells of arachnoid villi, hence attached to dura mater • Primary ONSM – Intraorbital or intracanalicular portion or ON – Less common • Secondary ONSM – Extension of intracranial meningioma into orbit – More common
- 48. Optic Nerve Sheath Meningioma 48 Dr. Ummara Shafiq PRESENTATION • Age…6th-8th decade • F>M • Chronic, painless, progressive visual impairment • Mostly unilateral • Headache • Double vision SIGNS • Classic triad – visual loss – optic atrophy – optociliary shunt vessels (30%) • Restrictive motility defect • Axial proptosis
- 49. Optic Nerve Sheath Meningioma 49 Dr. Ummara Shafiq WORK-UP • CT scan (with contrast) o Fusiform appearance of ON o Mostly at orbital apex o Calcifications usually seen o Bony involvement • MRI o Clearly show small tumors o Intraorbital extension of intracranial o Meningioma easily detected
- 50. Optic Nerve Sheath Meningioma 50 Dr. Ummara Shafiq TREATMENT • Observation – No intracranial extension and no vision loss • Radiotherapy – Primary radiation – Radiation after surgery • Chemotherarpy o Unresectable, recurrent, or previously irradiated o Combinations – 5-fluroouracil, folate, and levamisole • Surgical excision
- 51. Proptosis in Children 51 Dr. Ummara Shafiq • Orbital cellulitis • Dermoid cyst • Capillary hemangioma • Optic nerve glioma • Rhabdomyosarcoma
- 52. Orbital Cellulitis 52 Dr. Ummara Shafiq • Bacterial orbital cellulitis – life-threatening • Infection of soft tissues behind septum • More common in children • Organisms o S. pneumoniae o S. aureus o S. pyogenes o H. influenzae
- 53. Orbital Cellulitis 53 Dr. Ummara Shafiq • Sinus-related – Ethmoidal (90%) • Extension of preseptal cellulitis o Dacryocystitis o Facial cellulitis o Dental infections • Systemic bacteremia • Post-trauma o Penetrating septum (48- Penetrating septum • Post-surgical o Lacrimal o Orbital Etiology
- 54. 54 Dr. Ummara Shafiq • Malaise • Fever • Pain • Visual impairment • Tender, warm, red , periorbital edema • Proptosis • Painful Ophthalmoplegia • Chemosis • Rhinorrhea • Elevated IOP Orbital Cellulitis Presentation
- 55. 55 Dr. Ummara Shafiq WORK-UP • Vital signs record • WBC/blood culture • Lumbar puncture • CT orbit • MRI – For cavernous sinus thrombosis TREATMENT • Hospital admission + ENT consultation • I.V. antibiotics • Nasal decongestant • Antibiotic eye ointment Orbital Cellulitis
- 56. 56 Dr. Ummara Shafiq OCULAR • Exposure keratopathy • Raised IOP • CRVO, CRAO • Endophthalmitis • Optic neuropathy INTRACRANIAL • Meningitis • Brain abscess • Cavernous thrombosis • Orbital abscess • Periosteal abscess Orbital Cellulitis Complications:
- 57. 57 Dr. Ummara Shafiq INDICATIONS • Decreasing vision • Afferent pupillary defect • No response to antibiotics in 48-72 hrs • Orbital/Subperiosteal abscess • Atypical picture…..Needs biopsy • Canthotomy/Cantholysis in emergency • Surgical drainage of fluid • Orbital surgery + sinusotomy • Exenteration Orbital Cellulitis Surgical Treatment
- 58. 58 Dr. Ummara Shafiq • A choristoma, found adjacent to suture lines • Connected to periorbita by fibrovascular tissue • Content o Keratinized stratified squamous epithelium o Blood vessels, fat, collagen, sebaceous glands, and hair follicles o a tan oily liquid to a white or yellow substance Dermoid Cyst Definition
- 59. 59 Dr. Ummara Shafiq • A choristoma, found adjacent to suture lines • Connected to periorbita by fibrovascular tissue • Content o Keratinized stratified squamous epithelium o Blood vessels, fat, collagen, sebaceous glands, and hair follicles o a tan oily liquid to a white or yellow substance Dermoid Cyst Definition
- 60. 60 Dr. Ummara Shafiq • Mostly in children • Mostly…Superotemporal aspect of orbit • A painless mass • Slowly growing • Usually < 1 cm in diameter, non-tender • Globe displacement • Inflammation if ruptures • May – Compress optic nerve – Diplopia Dermoid Cyst Presentation
- 61. 61 Dr. Ummara Shafiq • CT/MRI o Indicated if posterior extent not palpated o Cystic appearance o Well circumscribed lesion Dermoid Cyst Workup
- 62. 62 Dr. Ummara Shafiq • Most common orbital tumor of infancy • Benign endothelial cells neoplasms • Absent usually at birth • Rapid growth in infancy • Involution later on Capillary Hemangioma Definition
- 63. 63 Dr. Ummara Shafiq • Thought … of placental origin • 02 phases of growth o Proliferative • Rapid growth…8-18 months • Increase in no. of endothelial & mast cells (stimulus for vessel growth) o Involutional • 30-50% involute by 5 years • 75% by 7 years Capillary Hemangioma Pathophysiology
- 64. 64 Dr. Ummara Shafiq • F:M…3:1 • 1-2% in neonates • All develop by 6 months • Typically…red spot growing in size in Periorbital area • Inability to open lids • Bulging of the eye CLASSIFIED • Cutaneous • Purely preseptal • Preseptal with extraconal element • Combination of preseptal, extraconal and intraconal Capillary Hemangioma Presentation
- 65. 65 Dr. Ummara Shafiq • Usually…superonasal , brow or lid lesion • Typically blanches with pressure • Ptosis & proptosis if posterior extension • Visual loss • Preseptal …Dark blue or purple • Enlarge & change color while crying Capillary Hemangioma Signs
- 66. 66 Dr. Ummara Shafiq Capillary Hemangioma Signs
- 67. 67 Dr. Ummara Shafiq Capillary Hemangioma Work-up • CT – poorly circumscribed mass with no bony erosion – Homogenous enhancing lesion • MRI – hypointense to fat on T1-weighted & hyperintense on T2-weighted scans • US & Doppler – For anatomic relations & extent
- 68. 68 Dr. Ummara Shafiq Capillary Hemangioma Mortality/Morbidity • Kasabach-Merritt syndrome o Coagulopathy, thrombocytopenia o large visceral / Nasopharyngeal hemangiomas o DIC may occur, high output CCF o Mortality…30-50% • Ophthalmic morbidity o Space occupying lesion o Amblyopia
- 69. 69 Dr. Ummara Shafiq Capillary Hemangioma Treatment • Medical o Observation o Steroids – Clobetasol propionate cream – Injectable steroid formulations – Systemic corticosteroids are used for amblyogenic lesions o Interferon alfa-2a – Resistant to steroid treatment • Surgery o Laser surgery • Carbon dioxide laser • Argon laser • Nd:YAG laser o Primary excision
- 70. 70 Dr. Ummara Shafiq Optic Nerve Glioma Definition • Most common primary tumor of ON o In children…mostly benign o In adults…Aggressive glioma • WHO classify it as o Grade I astrocytomas (pilocytic astrocytomas) o slow growing & tend not to metastasize • Generalized hyperplasia of glial cells in the nerve to complete disorganization • 10-38% of pediatric pts with ON glioma have NF-1 • Bilateral ON gliomas…almost pathognomonic for NF-1
- 71. 71 Dr. Ummara Shafiq Optic Nerve Glioma Presentation • ON gliomas are o 4% of orbital tumors o 2/3rd of all primary optic nerve tumors • 20% gliomas extend to the optic chiasm or beyond into the optic radiations & aggressive • F>M • Painless proptosis with inferior dystopia • Decreased vision • Large lesion can obstruct 3rd ventricle & ICP • Optic atrophy • Optociliary collaterals • CRVO
- 72. 72 Dr. Ummara Shafiq Optic Nerve Glioma Presentation
- 73. 73 Dr. Ummara Shafiq Optic Nerve Glioma Work-Up • CT o Diffuse Fusiform enlargement of the optic nerve • MRI o T1-weighted images – Isointense to hypointense o T2-weighted images – Isointense to hyperintense
- 74. 74 Dr. Ummara Shafiq Optic Nerve Glioma Treatment • Not required if o Not growing o Good vision o No cosmetic blemish • Surgical excision o Large & growing lesions o Confined to orbit • Radiotherapy + chemotherapy o Intracranial extension
- 75. 75 Dr. Ummara Shafiq Rhabdomyosarcoma Definition EMBRYONAL SARCOMA • Most common primary orbital malignancy of childhood • Origin…undifferentiated mesenchymal cells • Called Rhabdomyosarcoma if differentiate into striated muscle • The four main histological type:- 1. Embryonal 2. Botyroid 3. Alveolar 4. Pleomorphic
- 76. 76 Dr. Ummara Shafiq Rhabdomyosarcoma Presentation • Usually first decade (average…7yrs) • Boys > girls • Proptosis o Rapid (days to weeks) o Unilateral o Painful o Non-axial • Mimics orbital cellulitis • Swollen lids, bluish appearance • Ptosis • Chemosis
- 77. 77 Dr. Ummara Shafiq Rhabdomyosarcoma Presentation • Location o Superonasal o Retro bulbar o Superior o Inferior • Sinuses involvement & nose bleeds • Other findings o Disc edema o Choroidal folds o Decreased vision o Cervical lymph nodes involvement
- 79. 79 Dr. Ummara Shafiq Rhabdomyosarcoma Work-Up • USG o Relatively well-circumscribed mass• Low-medium amplitude echoes • CT & MRI o Moderately well-defined homogenous mass o Bony destruction
- 81. 81 Dr. Ummara Shafiq Rhabdomyosarcoma Treatment • Referred to pediatric oncologist • Radiotherapy • Chemotherapy • Surgery o Exenteration for recurrent & resistant
- 82. 82 Dr. Ummara Shafiq Lymphangioma Definition • Introduction o Non-Neoplastic o Non-functional o Abortive o Vascular malformation • Hemodynamically isolated • Bleeding into lumen…chocolate cysts
- 83. 83 Dr. Ummara Shafiq Lymphangioma Presentation • Early childhood (average=5-6 yrs) • Multiple bluish soft masses • Upper nasal quadrant • Cystic conjunctival component • Proptosis o Due to spontaneous hemorrhage o Painful o Axial/non-axial • Worsened by RTI • Palat involvement • Ptosis • Restricted eye movements • Optic nerve compression • Papilledema • Secondary glaucoma
- 85. 85 Dr. Ummara Shafiq Lymphangioma Work-Up • CT o Multilobulated cystic mass within the orbit and/or intralesional calcifications • MRI o Hemorrhagic cyst…Hyperintense o Fluid level
- 86. 86 Dr. Ummara Shafiq Lymphangioma Treatment • Conservative • Intralesional injection of the sclerosing agents • Needle aspiration • CO2 laser • Local radiotherapy • Cryotherapy • Partial surgical resection of cyst
- 87. 87 Dr. Ummara Shafiq Summary PROPTOSIS Lid edema Sinus disease Restricted motility Pain / Tender Lid trauma Fever Little/no inflammation Orbital lesion Young child/adult Slow growing Located near bone Sutures ORBITAL CELLULITIS DERMOID CYST
- 89. 89 Dr. Ummara Shafiq Summary PROPTOSIS Child (5 years) Upper nasal quadrant mass Painful Few episodes of proptosis Worsened by RTI MRI shows fluid levels Child (7-8 years) Hx of nose bleeds Bluish color lids Unilateral Lymph node involved Painful ORBITAL LYMPHANGIOMA RHABDOMYOSARCOMA
- 91. 91 Dr. Ummara Shafiq Summary PROPTOSIS Orbital inflammation Sudden onset/chronic Adults/children Prominent red eye Pain/Diplopia Trigeminal involvement Hx of trauma Severe conjunctival Chemosis Pulsatile Proptosis Orbital bruit ORBITAL PSEUDOTUMOR AV MALFORMATION
- 92. 92 Dr. Ummara Shafiq Summary PSEUDOTUMOR AV MALFORMATION
- 93. 93 Dr. Ummara Shafiq Summary PROPTOSIS Unilateral/bilateral Lid retraction/lag Heat intolerance Woman…20-40 years Thyroid bruit/enlarged THYROID EYE DISEASE ORBITAL METASTATIC TUMOR Middle-aged woman Slow growing Retropulsion Axial Proptosis Increased hyperopia Unilateral Rapid onset Proptosis Motility problems Orbital pain Diplopia Primary tumor (lung, breast) CAVERNOUS HEMANGIOMA
- 95. Dr. Ummara Shafiq 95 Any Questions?
- 96. Dr. Ummara Shafiq 96 Thank You