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Proptosis
This document discusses various causes of proptosis (forward protrusion of the eyeball), including thyroid eye disease, orbital inflammatory pseudotumor, infectious orbital cellulitis, optic nerve glioma, rhabdomyosarcoma, cavernous hemangioma, and orbital lymphomas. For each condition, it provides details on symptoms, diagnostic tools such as CT scans, characteristic findings, treatment options, and importance of systemic evaluation. Thyroid eye disease and orbital inflammatory pseudotumor are highlighted as common causes of bilateral proptosis, while rhabdomyosarcoma has the highest mortality risk if untreated and spreads beyond the orbit.
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Proptosis
- 1. By Dr Christina Samuel PostgraduateOphthalmology MMCH& RI
- 2. Forward protrusionof one or both eyeballs. Unilateral asymmetric protrusion of one eye by at least 2 mm.
- 3. Globes fromabove Measured with an exophthalmometer CT scan
- 4. 1. Exposurekeratopathy 2. Diplopia 3. Optic nerve compression
- 5. BILATERAL PROPTOSIS:BILATERAL PROPTOSIS: SEENMOST COMMONLY IN THROID EYE DISEASE.SEEN MOST COMMONLY IN THROID EYE DISEASE.
- 6. Orbital inflammatorypseudotumor Orbital infectious cellulitis Orbital tumors (benign or malignant) Lacrimal gland tumors Trauma (retrobulbar hemorrhage) Orbital vasculitis (i.e., polyartentts nodosa, Wegener's granulomatosis) Mucormycosis Carotid-cavernous fistula Orbital varix
- 7. Thyroid ophthalmopathy ◦multisystem. autoimmune disorder ◦ hyperthyroid, hypothyroid, euthyroid inflammation and enlargement EOM IR>MR>SR>LR fusiform enlargement sparing the tendon peribulbar tissues. ◦ Proptosis ◦ Eyelid retraction ◦ Corneal problems ◦ Diplopia ◦ Optic nerve compression ◦ Treatment depending on the severity ◦ Systemic and laboratory evaluation is mandatory
- 8. Orbital inflammatorypseudotumor ◦ nonspecific idiopathic inflammatory ◦ localized to muscle, lacrimal gland, sclera vs. diffuse ◦ eyelid erythema or edema ◦ palpable mass ◦ decreased vision ◦ uveitis ◦ hyperopic shift ◦ optic nerve edema ◦ Bilateral disease more common in children ◦ CT scan thickening 1+ EOM (inc. tendons) lacrimal gland enlargement thickening of the posterior sclera ◦ Treatment corticosteroids +/- radiation
- 9. Infectious orbitalcellulitis ◦ usually bacterial ◦ extended posterior to orbital septum ◦ meningitis ◦ cavernous sinus thrombosis ◦ staphylococci. streptococci. anaerobes, and Haemophilus influenza (in children under 5 years of age) ◦ most common source -- ethmoid sinusitis ◦ intravenous antibiotics
- 10. Orbital subperiostealabscess CT scan ◦ confirm diagnosis ◦ locate the abscess surgical drainage and continued intravenous antibiotics
- 11. Optic nerveglioma (juvenile pilocytic astrocytoma) ◦ slow-growing tumor ◦ Decreased visual acuity with a RAPD ◦ CT scan or MRI “fusiform” enlargement of the ON ◦ associated with NF1 Dx if bilateral ◦ Systemic evaluation and genetic counselling for NF is essential
- 12. Rhabdomyosarcoma ◦ mostcommon primary orbital malignancy of childhood ◦ malignant growth of striated muscle tissue ◦ rapidly progressive mass in the superior orbit with proptosis, globe displacement, and eyelid swelling ◦ average age of presentation is 7 years ◦ Prompt diagnosis with orbitotomy and biopsy is crucial ◦ overall mortality is 60% once the disease has extended to orbital bones ◦ Current Rx with radiation + chemo have lowered mortality rates to 5 to 10%
- 13. Cavernous hemangioma ◦slow-growing vascular tumor ◦ usually diagnosed in young adulthood to middle age ◦ CT scan ◦ intraconal well-defined orbital mass ◦ Visual acuity is often not affected. ◦ Treatment observation or surgical excision
- 14. Orbital lymphomas ◦typically superior orbit ◦ slow onset and progression ◦ subconjunctival “salmon-colored" mass in the fornix ◦ CT scan poorly defined mass conforming to the shape of the orbital bones and globe without bony erosion ◦ orbital biopsy ◦ definitive treatment is radiation ◦ associated with systemic lymphoma: therefore medical consult and systemic evaluation are necessary for all patients
- 15. Cavernous hemangioma Schwannoma Fibrohistiocytoma Neurofibroma Hemangiopericytoma
Editor's Notes
- #5 I.Exposure keratopathy frequently develops secondary to a poor blink mechanism over the protruding globe. Patients can have mild symptoms of irritation and foreign body sensation. or more severe symptoms associated with corneal abrasions and ulcers (see figure, next page). 2.Diplopia (double vision) can result from unilateral or bilateral proptosis from displace-ment of the globes or poor extraocular muscle function. 3.Optic nerve compression can occur with space-occupying lesions of the orbit. which cause proptosis. Indications of nerve compression include decreased visual acuity. relative affer-ent pupillary defect. color vision deficit. and visual field defect of the affected eye. This is a med-ical emergency and requires prompt therapeutic intervention. surgically or medically.