A 40-year-old male presented with a 4-month history of painless protrusion of the left eye associated with decreasing vision. Examination found unilateral, axial proptosis of the left eye measuring 25mm. Imaging and lab tests were performed to rule out other causes. The patient underwent an excisional biopsy via orbitotomy, which was sent for histopathology.

1. A CASE OF PROPTOSIS
Abubaker Ahmed MS ophth
dr-abubaker@hotmail.com

2. Clinical presentation
A 40 years old male presented to us complaining
of painless protrusion of the left eye 4 months
ago of insidious onset slowly progressive associated
with progressive diminution of vision in that eye .

6. Past history
 An old picture taken 4 years ago showing that
the proptosis is an old standing event .
 No history of trauma
 No history of any systemic diseases

8. Family history
 Not significant

9. General examination
 Well conscious and oriented of average
intelligence
 No signs of facial asymmetry
No signs of hyperthyroidism
 No signs of lymphadenopathy or
hepatosplenomegaly.
 No neurological manifestations

10. Ocular examination
 Visual acuity 6/18 corrected to 6/12 and 6/6 in the
healthy eye
 Mild limited ocular motility laterally and up and out
 Unsustained pupillary reaction to light
 Color test : +ve red desaturation test
 Intact corneal sensation and no punctate epithelial
erosion
 Fundoscopy shows disc swelling surrounded by hard
exudates and tortuous veins

13.  Fundus
dus Picture

14. Exclusion of pseudoproptosis
 No ipsilateral buphthalmos or high myopia
 No ipsilateral lid retraction
 No contralateral enophthalmos

15. Proptosis of the lt eye
 It is a unilateral , axial , non pulsatile not aggravated by
straining
 Not associated with lid edema ,chemosis or injection
 No thyroid eye signs
 Moderate in severity ( 25 mm by hertle
exophthalmometer and 15 mm in the healthy eye)
 +ve retropulsion
 No thrill or bruit

17. Investigations
 Complete blood count
 Kidney and liver function
 Thyroid hormonal profile
 CXR
 Abdominal US
 Ct orbit
 MRI

28. SURGICAL TREATMENT
 Excisional biopsy under general anesthesia
through transconjuctival medial orbitotomy
 The mass sanded for histopathological
examination