Differential Diagnosis of Proptosis Block 4.4 Movement (Ophthalmology Week) College of Medicine, King Faisal University Al-Ahsa, Saudi Arabia

1. Differential Diagnosis
of Proptosis
Abdullatiff Sami Al-Rashed
Movement Block 4.4 (Opthalmology Week)
212516770
College of Medicine, King Faisal University
Al-Ahsa, Saudi Arabia

2. Introduction
• Proptosis, or exophthalmos, is a protrusion of the eye
caused by a space occupying lesion.
• Can be either bilateral or unilateral.
• Measurement of the degree of exophthalmos is
performed using an exophthalmometer.

3. Exophthalmometer
A difference of prominence of more than 2 mm between the two eyes is
significant.

10. Graves disease

11. Introduction
• Autoimmune disorder with orbital
involvement and associated with thyroid
dysfunction.
• Women are affected more than men.
• Proptosis could be unilateral or bilateral

12. Symptoms

13. Eyelid Signs in Graves Disease
Dalrymple sign:
Upper eyelid is retracted with visible sclera
superior to the limbus and widened palpebral
fissure with developing exposure keratitis
(overactive muscle of Müller)

14. Eyelid Signs in Graves Disease
Gifford sign:
Upper eyelid is difficult to evert (due to eyelid
edema)

15. Eyelid Signs in Graves Disease
Von Graefe sign:
Upper eyelid retracts when the eye
depresses (overactive muscle of Müller)

16. Eyelid Signs in Graves Disease
Stellwag Sign (Rare blinking)

17. Eyelid Signs in Graves Disease
Kocher sign ( Fixed Gaze )

18. Diagnosis

19. Treatment
• Methylcellulose or hypromellose eyedrops:
– To aid lubrication and improve comfort.
• Systemic steroids (prednisolone 30–120 mg daily):
– usually reduce inflammation if more severe symptoms are
present.
• Surgical decompression of the orbit:
– Particularly if pressure of orbital contents on the optic nerve
threatens vision.
• Lid surgery:
– Protect the cornea if lids cannot be closed.

20. Orbital cellulitis

21. Introduction
• Acute inflammation of the contents of the
orbital cavity with the cardianl symptoms
of limited motility and general malaise.
• Orbital cellulitis is the most frequent cause
of exophthalmos in children.

22. Symptoms

23. Symptoms

24. Investigations
Test Results
CBC Leukocytosis
ESR Increased
Blood culture To detect specific organisms
Nasal swap For gram stain
CT scan orbit
MRI For orbital abscess and evaluating
for cavernous sinus disease

25. Complications
Optic neuritis Cavernous sinus
thrombosis

26. Treatment
• High-dose intravenous antibiotic therapy:
– Infants are treated with ceftriaxone and school-age
children with oxacillin combined with cefuroxime in the
appropriate doses.
• Treatment of underlying sinusitis
– Indicated in applicable cases.

27. Orbital Hemingioma

28. Hemangioma
• Hemangiomas are the most common benign orbital
tumors in both children and adults.
• They usually occur in a nasal superior location.
• Capillary hemangiomas are more common in children
(they swell when the child screams)
• Cavernous hemangiomas are more common in adults.

30. Hemangioma
• Treatment is only indicated where the tumor
threatens to occlude the visual axis with
resulting amblyopia or where there is a risk of
compressive optic neuropathy.
• Capillary hemangiomas in children can be
treated with cortisone or low-dose radiation
therapy.

31. Other causes of proptosis

33. References