Proptosis in Adults : Proptosis in Adults Dr. Anchal Gupta 1 What is Proptosis : What is Proptosis is one of the most common clinical manifestations of an orbital abnormality
defined as an abnormal prominence of one or both eyes, usually resulting from a mass, a vascular abnormality or an inflammatory process 2 Slide 3: Among adults, the usual distance from the lateral orbital rim to the corneal apex is approximately 16 mm-21 mm.
1.protrusion more than 22mm
beyond the orbital rim.
2.An asymmetry of more than 2 mm
between the eyes. 3 Slide 4: Most common cause of unilateral Proptosis-Thyroid eye disease (Graves' ophthalmopathy)
Most common cause of bilateral Proptosis-is also Thyroid eye disease 4 How it is different from Exophthalmos : How it is different from Exophthalmos the word exophthalmos for those cases of proptosis secondary to endocrinological dysfunction.
Therefore the dictum is-non–endocrine mediated globe protrusion will be referred to as proptosis and exophthalmos will be reserved for protrusion secondary to endocrinopathies. 5 How it is different from pseudo-proptosis : How it is different from pseudo-proptosis either the simulation of an abnormal prominence of the eye or a true asymmetry that is not caused by a mass, a vascular abnormality, or an inflammatory process 6 Causes of pseudoexophthalmos : Causes of pseudoexophthalmos Enlarged globe.
Asymmetric orbital size.
Asymmetric palpebral fissure.
Facial nerve paralysis.
Lid scar, ectropion, entropion. -Extra ocular muscle abnormalities.
Postsurgical muscle recession.
Paralysis or paresis.
-Contra lateral enophthalmos.
Contra lateral orbital fracture.
Contra lateral small globe.
Contra lateral cicatricial tumor 7 Physiological Proptosis : Physiological Proptosis in infants due to the fact that orbital cavities do not attain their full size so rapidly as the eyes like the brain has a precocious devolvement 8 Classification of true proptosis : Classification of true proptosis 1. a) Acute
b) Non pulsalating
b)Ecentric 9 Causes of acute proptosis in adult : Causes of acute proptosis in adult Orbital cellulitis
Inflammatory pseudo tumor
Thyroid related orbitopathy
Cavernous sinus thrombosis
Metastatic cancer of orbit
Carcinama of lacrimal gland 10 Causes of intermittent proptosis in adult : Causes of intermittent proptosis in adult Orbital varices -90%
Highly vascular orbital neoplasm-hemangioma
Recurrent orbital heamorrage
Recurrent emphysema of orbit
Intermittent ethymoiditis 11 Causes of chronic proptosis in adult : Causes of chronic proptosis in adult Orbital malformation-
-Enlarged lacimal gland
-Optic nerve glioma
-Optic nerve sheath maningiomas 12 .Secondary tumors
-Spheriod ridge maningioma
.Xanthogrnuloma Pulsatile proptosis : Pulsatile proptosis True vascular
Carotid cavernous fistula
AV aneurysm in the orbit b/w ophthalmic artery $ orbital vein
In neck – Carotid artery $ jugular vein
Highly vascular orbital tumor
Orbital varies Transmitted
Congenital failure in the development of roof of the orbit
Traumatic or operative hiatus in orbit roof resulting in the formation of maningocoel 13 Unilateral : Unilateral Thyroid related opthalmopathy
Acute inflamatory lession
Chronic inflamatory lessions
A) Inflammatory pseudo tumor
B) Tb of orbit
- CCF Vascular
A) Orbital Varices
B) Capillary hemangiomas
C) Cavernous hemangiomas
D) Lymphangioma 14 Bilateral proptosis : Bilateral proptosis Congenital orbital and facial malformation
Thyroid related opthalmopathy
Metastasis from neuroblastoma,leukemia,lymphoma
Cavernous sinus thrombosis 15 Axial Proptosis : Axial Proptosis Thyroid related opthalmopathy
Glioma of optic nerve
Optic nerve sheath Meningioma
Cavernous sinus Meningioma 16 Eccentric Proptosis : Eccentric Proptosis Down and out
Frontal and ethmoidal mucoceal
Down and in
Lacrimal gland tumor
Carcinoma of maxillary sinus
Lession of anterior ethmoidal sinus
Naspharengeal tumor 17 How to examine a case of Proptosis : How to examine a case of Proptosis History
h/o headache ,vomiting or other sign of ICT
Fever, ENT complain
Thyroid swelling and symptoms
Trauma 18 Ocular examination : Ocular examination Inspection
Head posture, Facial asymmetry
If true –unilateral /bilateral
Presence of swelling ,edema , congestion of lids 19 Slide 20: Palpation
Finger can be passed between swelling and globe
Reducibility- hemangioma , lymphangioma , orbital varices 20 Slide 21: Pulsation
True – finger will raise and separated
Transmitted – finger will raise only Auscultation
For bruit over eye ball – AV malformation 21 Measurement of proptosis : Measurement of proptosis 22 Slide 23: 23 Slide 24: 24 Slide 25: 25 Slide 26: 26 Slide 27: 27 Slide 28: 28 Slide 29: Thanks u 29 Slide 30: Infectious
Concurrent sinus disease
Orbital inflammatory syndrome
Churg-Strauss syndrom Neoplastic
Metastatic (breast in women, lung and prostate in men, gastrointestinal, kidney)
Orbital vascular disease
Orbital varix (venous malformation)
Orbital arteriovenous malformation (carotid-cavernous sinus fistula, arteriovenous malformation)
Traumatic or iatrogenic orbital hemorrhage
Facial fractures 30 Evaluation : Evaluation History-
A)what possibility exist for a patient of certain age group- New born – orbital sepsis
Optic nerve glioma
Lymphomas Young adults- Dysthroid state
Middle age- pseudo tumour
Malignant lymphomas/ leukemias
Optic nerve sheath maingiomas
Senile- malignant and met static tumor of orbit