This document summarizes a study on proptosis, or forward displacement of the eye, in pediatric patients. The study aimed to analyze the incidence, etiological factors, correlation with investigations, and management/outcomes of childhood proptosis. It found that the most common causes were orbital cellulitis secondary to sinusitis and cavernous sinus thrombosis. Aggressive antibiotic treatment and supportive care led to complete recovery in most cases. Early and prompt therapy was determined to lead to satisfying outcomes.

1. PROPTOSIS IN PEDIATRIC PATIENTS
prospective study by
DR VIJAYLAXMI SHRIVASTAVA
DR G. MALINI
JAWAHARLAL NEHRU HOSPITAL & RESEARCH CENTRE
STEEL PLANT HOSPITAL

2. INTRODUCTION
• ANTERIOR DISPLACEMENT OF GLOBE OF
EYE BY >20 mm
• >2mm DIFFERENCE BETWEEN APEX OF
CORNEA OF TWO EYES
• CHILD WITH PROPTOSIS IS GROTESQUE
TO LOOK AT

3. INTRODUCTION
PERMANENT SEQUELAE
• CORNEAL ULCERATION
• CORNEAL OPACITY
• OPTIC ATROPHY
• BLINDNESS

4. INTRODUCTION
OTOLARYNGOLOGIST
OPTHALMOLOGIST
ONCOLOGIST
RADIOLOGIST PROPTOSIS CLINICIAN
PATHOLOGIST NEUROSURGEON

5. AIMS & OBJECTIVES
TO ANALYSE
• INCIDENCE
• ETIOLOGICAL FACTORS
• CORRELATION WITH
INVESTIGATIONAL MODALTIES
• MANAGEMENT & OUTCOME
OF CHILDHOOD PROPTOSIS

6. MATERIALS & METHODS
• PROSPECTIVE STUDY
• DURATION:THE CALENDER YEAR 2007.
• CASES WITH PROPTOSIS ADMITTED IN
THE PEDIATRICS WARD DURING ABOVE
PERIOD

7. MATERIALS & METHODS
• HISTORY
• EXAMINATION
• INVESTIGATION
• MANAGEMENT
• FOLLOW UP

8. OBSERVATIONS
AGE DISTRIBUTION
2
NUMBER
1
0
6 MONTHS 4 YEAR 8 YEAR 9 YEAR 13 YEAR
MOST CASES WERE TODDLERS - 4/7

9. OBSERVATIONS CONTD
SEX DISTRIBUTION
2
FEMALE
MALE
5
• TOTAL n= 7
• MALE 5/7

10. OBSERVATIONS CONTD:
2
BILATERAL
UNILATERAL
5
• TOTAL n=7

11. PRESENTING COMPLAINTS
7
6
5
4
3
2 5 5
1 3 2
0
HEADACHE PAIN FEVER VOMITING

12. DURATION OF COMPLAINTS
15
14
15
13 12
12
11
10
10
9
8
DAYS 8
7 7
6
5
4 5
3
2
2
1
0

13. PREDISPOSING FACTOR
SINUSITIS-ETHMOIDAL, 3
SPHENOIDAL, & MAXILLARY
FURUNCULOSIS OF NOSE 1
UPPER RESPIRATORY TRACT 1
INFECTION
DENTAL CARIES 1
CONJUCTIVITIS 1

16. SIGNS
7 7
6
5
4 4
4
3 3
3
2
2
1
1
0
LID EDEMA CHEMOSIS MENINGEAL
6 N PALSY 4 N PALSY 3 N PALSY
SIGNS CONVULSI
ON

20. PUPILLARY REACTION
4 3
4/7
NORMAL
DILATED & SLUGGISH REACTION TO LIGHT

21. FUNDUS EXAMINATION
3
3/7
4
NORMAL PAPILLEDEMA

23. INVESTIGATIONS
• HEMOGRAM
• BLOOD CULTURE & SENSITIVITY
• PUS/SWAB CULTURE & SENSITIVITY
• CT SCAN HEAD

24. INVESTIGATIONS
SPECIAL
• COAGULATION PROFILE
• MANTOUX TEST
• ELECTROPHORESIS
• CSF STUDY
• PROTEIN C ,PROTEIN S LEVELS

25. ETIOLOGY
5 3 ORBITAL CELLULITIS WITH
3 3 SINUSITIS WITH CAVERNOUS SINUS
4 THROMBOSIS
ORBITAL CELLULITIS
3
1 RHABDOMYOSARCOMA
2
PROTHROMBOTIC DISORDER
1
0

26. CAVERNOUS SINUS
THROMBOSIS

27. ORBITAL CELLULITIS

28. RHABDOMYOSARCOMA

29. MANAGEMENT
• CONSERVATIVE
• SURGICAL INTERVENTION
• CHEMOTHERAPY

30. CONSERVATIVE MANAGEMENT
• MANAGEMENT OF SHOCK
• AGGRESSIVE ANTIBIOTIC COVERAGE
• TOPICAL ANTIBIOTICS & EYE CARE
• LMWH(ENOXAPARIN)- IN 1 CASE OF
CAVERNOUS SINUS THROMBOSIS
• SUPPORTIVE THERAPY

31. ONCOLOGICL MANAGEMENT
CHEMOTHERAPY
VAC - VINCRISTINE
-ACTINOMYCIN
- CYCLOPHOSPHAMIDE

32. SURGICAL MANAGEMENT
• INCISION & DRAINAGE OF ABSCESS
• CRANIOTOMY & EVACUATION OF PUS
• SINUS DRAINAGE
• EXTRACTION OF CARIES TEETH

33. COMPLICATIONS
COMPLICATIONS RATE OTHER OUR
STUDIES STUDY
VISUAL IMPAIRMENT 10-30% 14%
CAVERNOUS SINUS 40% 42%
THROMBOSIS
NEUROLOGICAL 50% 14%
DEFICIT

35. NO COMPLICATIONS ON FOLLOW UP

36. CRANIAL NERVE PALSY WITH
VISUAL IMPAIRMENT

37. DISCUSSION
STUDY COMPARISON DATA
MALE 2.5:1 AGRAWAL 1.9%
:FEMALE etal(1979)
RATIO
BELMEKKI 2%
(1999)
NAGESWARAN 2.7%.
etal(2006)
SEEMA etal (2006) 1.6%

38. DISCUSSION
STUDY COMPARISON DATA
AGE LESS 57% AGRAWAL 60%
THAN 5 etal(1979)
YEARS
UNILATERA 71% MERCHANT etal 68%
L (1993)

39. DISCUSSION
RISK STUDY COMPARISON DATA
SINUSITIS 42% RODRIQUEZ 68%
etal(2000)
LID & FACE 28 % RODRIQUEZ 28 %
INFECTION etal(2000)

40. DISCUSSION
STUDY COMPARISON DATA
INFLAMMATO 71% SINDHU etal(1998) 39%
RY ETIOLOGY
MAJEKODUNMI 52%.
etal
(NIGERIA 1982)

41. DISCUSSION
STUDY COMPARISON DATA
BLOOD 14% SEAN etal (1998) 10%
CULTURE
GOMEZ 23%
etal(1996).

42. DISCUSSION
STUDY COMPARISON DATA
SURGERY 57% NAGESWARAN etal 71%
(2006).

43. CONCLUSION
• NOT UNCOMMON
• INFLAMMATION FROM ADJACENT SITE
• CAVERNOUS SINUS THROMBOSIS
FREQUENT
HIGH MORTALITY

44. CONCLUSION
• PERMANENT DEFICIT
• PROTHROMBOTIC STATES COEXISTS

45. CONCLUSION
EARLY & PROMPT THERAPY LEADS TO
COMPLETE RECOVERY & SATISFYING
OUTCOME