proptosis

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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

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Among adults, the usual distance from the lateral orbital rim to the corneal apex is approximately 16 mm-21 mm. Proptosis- 1.protrusion more than 22mm beyond the orbital rim. 2.An asymmetry of more than 2 mm between the eyes. 3

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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. Myopia. Trauma. Glaucoma. Asymmetric orbital size. Congenital. Postradiation. Postsurgical. Asymmetric palpebral fissure. Contralateral ptosis. Lid retraction. 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) Intermittent c) Chronic 2.a) Pulsatile b) Non pulsalating 3.a)Painful Proptosis b)Painless Proptosis 4.a)Axial b)Ecentric 9

Causes of acute proptosis in adult : 

Causes of acute proptosis in adult Orbital cellulitis Inflammatory pseudo tumor Thyroid related orbitopathy Orbital varices Av malformation Cavernous sinus thrombosis Posterior scleritis 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- -maningoencephalocoel .Choriostomas -teratoma -dermoid -Enlarged lacimal gland .Hemartomas -Cavernous hemangiomas -Lymphangiomas -Neurofibromas .Primary neoplasm -Optic nerve glioma -Optic nerve sheath maningiomas 12 .Secondary tumors -Retinoblastoma -Meduloepithilioma -Spheriod ridge maningioma .Metastatic tumor -Neuroblastoma .Leukemias .Lymphomas .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 A)orbital cellulitis B)Dacro adenitis Chronic inflamatory lessions A) Inflammatory pseudo tumor B) Tb of orbit Traumatic - RBH - 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 Wegner`s granulomatosis 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 Dermoid Dermolipma Frontal and ethmoidal mucoceal Meningicoel Down and in Lacrimal gland tumor Dermoid Upwards Carcinoma of maxillary sinus Outward 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 Defective vision Diplopia Fever, ENT complain Thyroid swelling and symptoms Trauma 18

Ocular examination : 

Ocular examination Inspection Head posture, Facial asymmetry True/pseudo proptosis If true –unilateral /bilateral Axial/eccenteric Presence of swelling ,edema , congestion of lids 19

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Palpation Orbital margin Finger can be passed between swelling and globe Reducibility- hemangioma , lymphangioma , orbital varices 20

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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

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Thanks u 29

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Infectious Orbital cellulitis Mucormycosis Concurrent sinus disease Inflammatory Orbital inflammatory syndrome Thyroidopathy Vasculitis Wegener granulomatosis Churg-Strauss syndrom Neoplastic Lacrimal Lymphoma Leukemia Meningioma Glioma 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) Trauma Traumatic or iatrogenic orbital hemorrhage Orbital fractures Facial fractures 30

Evaluation : 

Evaluation History- A)what possibility exist for a patient of certain age group- New born – orbital sepsis Orbital neoplasm Children- Rahabdomyosarcoma Hemangioma Dermoid cyst Orbital cellulites Optic nerve glioma Cranio synstosis Lymphomas Young adults- Dysthroid state Pseudotumor Cellulites Osteomas Infiltrative tumors Middle age- pseudo tumour Endocrine Malignant lymphomas/ leukemias Optic nerve sheath maingiomas Mucocele Senile- malignant and met static tumor of orbit Pseudotumor Leukemia Lymphomas Sarcomas 31