This document provides an overview of proptosis (abnormal protrusion of the eyeball), including its pathophysiology, classification, evaluation, and management. Proptosis is evaluated through history, examination of the eye and surrounding areas, imaging tests like CT and MRI, and blood tests. Causes can include infections, inflammation, vascular abnormalities, tumors, or idiopathic factors. Treatment depends on the underlying etiology but may involve medications, surgery, or radiation therapy.

1. Dr. Ashma Shrestha
1st Year Resident
LEIRC, NAMS
29th September 2021
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2.  Introduction
 Pathophysiology
 Classification
 Evaluation
 History
 Examination
 Investigation
 Imaging
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3.  An abnormal protrusion of one or both eye balls
 Anterior displacement of globe by >21mm from lateral orbital
rim
 >2mm difference between apex of cornea between two eyes
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4.  Exophthalmos
 Exorbitism
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5.  Ipsilateral eyelid retraction
 Macrophthalmos
 Contralateral ptosis
 Contralateral enophthalmos
 Contralateral micropththalmos
 Shallow orbit
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6. Increase in volume within
fixed bony orbit
Contents of orbit are
displaced anteriorly
Globular protrusion of eyeball
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7.  Etiology
 Duration
 Direction of globe displacement
 Laterality
 Age of onset
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8.  Infectious
 Inflammatory
 Vascular
 Neoplastic
 Idiopathic
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9.  Acute
 Subacute
 Chronic
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10. Axial
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Optic nerve glioma
Metastasis
Thyroid eye disease

11. Non-axial
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Superior
Maxillary sinus tumors
Inferomedial
Dermoid cyst Lacrimal gland tumor

12. Inferolateral
 Fronto-ethmoidal mucocele
 Abscess
 Sinus carcinomas
 Osteomas
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13. Unilateral Proptosis
 Congenital
 Traumatic
 Inflammatory
 Vascular
 Thyroid eye disease
 Cysts of orbit
 Tumors
 Mucocele of PNS
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14. Bilateral Proptosis
 Thyroid eye disease
 Developmental anomalies of skull
 Inflammatory
 Tumors
 Osteopathies
 Systemic disease
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15. Infants
 Congenital lesions
 Retinoblastoma
 Capillary hemangioma
 Juvenile xanthogranuloma
 Metastatic neuroblastoma
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16. Children
 Orbital cellulitis
 Dermoid cyst
 Capillary hemangioma
 Optic nerve glioma
 Rhabdomyosarcoma
 Retinoblastoma
 Leukemia
 Lymphangioma
 Metastasis
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17. Adults
 Thyroid exophthalmos
 Orbital cellulitis
 Trauma
 Meningioma
 Lymphoma
 Histiocytoma
 Cavernous hemangioma
 Varices
 Carotid-cavernous fistula
 Tumors extending from
adjacent areas
 Metastasis
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18. History Local
Examination
Systemic
Examination Investigations Imaging
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19.  Onset of proptosis
 Course and progression of proptosis
 History of trauma
 Associated symptoms of pain, diplopia, reduction of vision
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20.  Thyroid disease
 Diabetes
 Tuberculosis
 Sarcoidosis
 Neurofibromatosis
 Systemic cancer
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21.  Ocular disease
 Cancer
 Systemic familial disease
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22.  Inspection
 Palpation
 Auscultation
 Measurement of proptosis
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23.  General ocular appearance
 Eyelid
 Lacrimal drainage system
 Conjunctiva
 Cornea
 Iris
 Pupil
 Ocular motility
 Fundus
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24. General Ocular Appearance
 Facial asymmetry
 Globe displacement
 Pulsating proptosis
 Positional proptosis
 Color
 Surrounding area
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25. Eyelid
 Lid retraction
 Lid lag
 Ptosis
 Ecchymosis
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26. Eyelid
 S-Shaped eye lid
 Eczematous lesion of eyelid
 Edematous swelling of lower eyelid
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27. Conjunctiva
 Localized hyperemia
 Salmon colored patch
 Dilated episcleral vessels
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28. Cornea
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29. Iris Pupil
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30. Ocular motility
 Restrictive myopathy
 Optic nerve sheath meningioma
 Neurological deficit from orbital
apex lesions
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31. 32
Fundus
 Optic disc edema
 Optic atrophy
 Choroidal folds
 Retinal vascular changes
Disc edema
Choroidal folds

32.  Retrodisplacement of globe
 Pulsation of globe
 Thrill
 Palpation of orbital rim
 Palpation of anterior orbital mass
 Regional lymph nodes
 Paranasal sinuses
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34. Worms eye view
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35. Naffziger’s Method
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36. Plastic ruler test
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37. Luedde’s Exophthalmometer
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38. Hertel’s Exophthalmometer
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39.  Mild- 21-23mm
 Moderate- 24-27mm
 Severe- 28mm or more
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40. Naugle’s Exophthalmometer
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41. 42
6P’s
Pain
Progression
Proptosis
Pulsation
Palpation
Periorbital Changes

42.  Transillumination
 Visual acuity and refraction
 Tonometry
 Forced duction test
 Diplopia charting
 Color vision
 Visual field evaluation
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43.  Skin pigmentation
 Café au lait spots
 Features of thyroid disease
 Organomegaly or lumps in abdomen
 Nasopharyngeal mass
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44.  Hematological
 Thyroid function tests
 Serum ANA, C-ANCA, ACE
 Chest Xray
 Mantoux test
 Casoni’s test
 Stool examination
 Urine analysis
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45.  Noninvasive
 Plain X-ray
 Orbital USG
 CT Scan
 MRI
 Invasive
 Orbital venography
 Carotid angiography
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46.  Plain X-rays
 Enlargement of orbital cavity
 Calcification, hyperostosis
 Computed tomography
 Shape, location, extent and character of lesions in orbit
 Measurement of proptosis
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47.  Ultrasonography
 Usually differentiate between solid, cystic, infiltrative and spongy
masses
 Lesions of posterior orbit cannot be viewed
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48.  Magnetic Resonance Imaging
 Provides more soft tissue detail
 Better technique for orbitocranial junction or intracranial imaging
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49.  Orbital Venography
 Definitive diagnostic study in evaluation of intermittent proptosis
 Carotid Angiography
 Pulsating proptosis with bruit or thrill
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50.  Fine Needle Aspiration Cytology
 Incisional biopsy
 Excisional biopsy
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51.  Basic and Clinical Science Course; Orbit, Eyelids and Lacrimal
System, AAO 2019-2020
 Disease Of Orbit, Jack Rootman, 2nd Edition
 Kanski’s Clinical Ophthalmology,9th Edition
 Disease Of Eye, Parson, 22nd Edition
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