Exophthalmos: Difference between revisions
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==Overview== | ==Overview== | ||
'''Exophthalmos''' is a bulging of the [[eye]] anteriorly out of the [[orbit (anatomy)|orbit]]. | '''Exophthalmos''' is a bulging of the [[eye]] anteriorly out of the [[orbit (anatomy)|orbit]]. Some sources define exophthalmos as a protrusion of the globe greater than 18 mm and proptosis as a protusion equal to or less than 18 mm. (Epstein et al, 2003). Others define "exophthalmos" as protusion secondary to endocrine dysfunction and "proptosis" as any non-endocrine-mediated protusion<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>. | ||
Exophthalmos can be either bilateral (as is often seen in [[Graves-Basedow disease|Grave's Disease]]) or unilateral (as is often seen in an orbital tumor). Measurement of the degree of exophthalmos is performed using an exophthalmometer. Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma. | |||
In the case of Graves Disease, the displacement of the eye is due to abnormal connective tissue deposition in the orbit and extraocular muscles which can be visualized by [[Computed axial tomography|CT]] or [[MRI]].<ref>{{cite book | author = Owen Epstein, David Perkin, John Cookson, David P de Bono | title = Clinical examination | edition=3rd edition | publisher = Mosby | location = St. Louis | year = 2003 | month=April | id = ISBN 0-7234-3229-5 }}</ref> | In the case of Graves Disease, the displacement of the eye is due to abnormal connective tissue deposition in the orbit and extraocular muscles which can be visualized by [[Computed axial tomography|CT]] or [[MRI]].<ref>{{cite book | author = Owen Epstein, David Perkin, John Cookson, David P de Bono | title = Clinical examination | edition=3rd edition | publisher = Mosby | location = St. Louis | year = 2003 | month=April | id = ISBN 0-7234-3229-5 }}</ref> | ||
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If left untreated, exophthalmos can causes the eye lids to fail to close during sleep leading to [[cornea|corneal]] damage. The process that is causing the displacement of the eye may also compress the [[optic nerve]] or [[ophthalmic artery]] leading to [[blindness]]. | If left untreated, exophthalmos can causes the eye lids to fail to close during sleep leading to [[cornea|corneal]] damage. The process that is causing the displacement of the eye may also compress the [[optic nerve]] or [[ophthalmic artery]] leading to [[blindness]]. | ||
===Complete Differential Diagnosis of the Causes of Exophthalamus === | ===Complete Differential Diagnosis of the Causes of Exophthalamus === | ||
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*[[Cavernous Sinus Thrombosis]] | *[[Cavernous Sinus Thrombosis]] | ||
*[[Churg-Strauss syndrome]] | *[[Churg-Strauss syndrome]] | ||
* | *Cloverleaf skull syndrome | ||
*[[ | *Cole-[[Carpenter syndrome]] | ||
*[[Corneal ulcer]] | *[[Corneal ulcer]] | ||
* | *Crouzon craniofacial dysostosis (Crouzon syndrome) | ||
*[[Dalrymple's sign]] | *[[Dalrymple's sign]] | ||
*[[Dermoid cyst]] | *[[Dermoid cyst]] | ||
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*[[Infiltrative ophthalmopathy]] | *[[Infiltrative ophthalmopathy]] | ||
*Insulin receptor defect with insulin-resistant diabetes mellitus | *Insulin receptor defect with insulin-resistant diabetes mellitus | ||
* | *Lowry-MacLean syndrome | ||
*[[Meningioma]] | *[[Meningioma]] | ||
*[[Mucormycosis]] | *[[Mucormycosis]] | ||
*Nasal type natural killer/T-cell [[lymphoma]] | *Nasal type natural killer/T-cell [[lymphoma]] | ||
* | *Neu-Laxova syndrome | ||
*[[Neuroblastoma]] | *[[Neuroblastoma]] | ||
*[[Neurofibromatosis]] | *[[Neurofibromatosis]] | ||
*[[ | *Optic [[glioma]] | ||
*Orbital [[cellulitis]] | *Orbital [[cellulitis]] | ||
* | *Orbital inflammatory pseudotumor | ||
*Orbital mass or tumors | *Orbital mass or tumors | ||
*Osteodysplasty (Melnick-Needles) | *Osteodysplasty (Melnick-Needles) | ||
*[[Polyarteritis nodosa]] | *[[Polyarteritis nodosa]] | ||
*[[ | *Pseudo[[proptosis]] (buphthalmos, contralateral enophthalmos | ||
ipsilateral lid retraction, axial myopia, contralateral blepharoptosis) | ipsilateral lid retraction, axial myopia, contralateral blepharoptosis) | ||
*[[Raine syndrome]] | *[[Raine syndrome]] | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Infectious Disease''' | | '''Infectious Disease''' | ||
|bgcolor="Beige"| orbital cellulitis, endophthalmitis, sinusitis, [[ | |bgcolor="Beige"| orbital cellulitis, endophthalmitis, sinusitis, [[aspergillosis]], [[mucormycosis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Oncologic''' | | '''Oncologic''' | ||
|bgcolor="Beige"| Histiocytosis X, nasal type natural killer/T-cell lymphoma, [[ | |bgcolor="Beige"| Histiocytosis X, nasal type natural killer/T-cell lymphoma, [[hemangioma]], [[meningioma]], [[neuroblastoma]], [[neurofibromatosis]], optic [[glioma]], [[retinoblastoma]], [[Von Recklinghausen's disease]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Opthalmologic''' | | '''Opthalmologic''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| orbital inflammatory pseudotumor, orbital [[mass]], [[corneal ulcer]], Pseudo[[proptosis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
Revision as of 19:02, 11 June 2009
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Overview
Exophthalmos is a bulging of the eye anteriorly out of the orbit. Some sources define exophthalmos as a protrusion of the globe greater than 18 mm and proptosis as a protusion equal to or less than 18 mm. (Epstein et al, 2003). Others define "exophthalmos" as protusion secondary to endocrine dysfunction and "proptosis" as any non-endocrine-mediated protusion[1] [2].
Exophthalmos can be either bilateral (as is often seen in Grave's Disease) or unilateral (as is often seen in an orbital tumor). Measurement of the degree of exophthalmos is performed using an exophthalmometer. Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma.
In the case of Graves Disease, the displacement of the eye is due to abnormal connective tissue deposition in the orbit and extraocular muscles which can be visualized by CT or MRI.[3]
If left untreated, exophthalmos can causes the eye lids to fail to close during sleep leading to corneal damage. The process that is causing the displacement of the eye may also compress the optic nerve or ophthalmic artery leading to blindness.
Complete Differential Diagnosis of the Causes of Exophthalamus
(In alphabetical order)
- Arteriorvenous malformation
- Aspergillosis (invasive, orbital)
- Basedow syndrome (combination of hyperthyroidism, goitre, and exophthalmos )
- Boston's sign (spasmodic lowering of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter)
- Carotid-cavernous fistula
- Cavernous Sinus Thrombosis
- Churg-Strauss syndrome
- Cloverleaf skull syndrome
- Cole-Carpenter syndrome
- Corneal ulcer
- Crouzon craniofacial dysostosis (Crouzon syndrome)
- Dalrymple's sign
- Dermoid cyst
- Endophthalmitis
- Erdheim-Chester disease
- Graves' disease
- Hemangioma
- Histiocytosis X
- Hyperthyroidism
- Infiltrative ophthalmopathy
- Insulin receptor defect with insulin-resistant diabetes mellitus
- Lowry-MacLean syndrome
- Meningioma
- Mucormycosis
- Nasal type natural killer/T-cell lymphoma
- Neu-Laxova syndrome
- Neuroblastoma
- Neurofibromatosis
- Optic glioma
- Orbital cellulitis
- Orbital inflammatory pseudotumor
- Orbital mass or tumors
- Osteodysplasty (Melnick-Needles)
- Polyarteritis nodosa
- Pseudoproptosis (buphthalmos, contralateral enophthalmos
ipsilateral lid retraction, axial myopia, contralateral blepharoptosis)
- Raine syndrome
- Relapsing polychondritis
- Retinoblastoma
- Schinzel-Giedion midface-retraction syndrome
- Sinusitis
- Stellwag's sign (infrequent or incomplete blinking associated with exophthalmos or Graves orbitopathy)
- Sturge-Weber syndrome
- TAO (Thyroid associated orbitopathy)
- Tolosa-Hunt syndrome
- Trauma
- Von Graefe's sign (immobility or lagging of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter)
- Von Recklinghausen's disease (Neurofibromatosis)
- Wegener granulomatosis
Make sure that each diagnosis is linked to a page.
Complete Differential Diagnosis of the Causes of ...
(By organ system)
| Cardiovascular | Carotid-cavernous fistula
Cavernous sinus thrombosis, Tolosa-Hunt syndrome, Hemangioma |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | Orbital inflammatory pseudotumor, Orbital mass, Sinusitis |
| Endocrine | Basedow syndrome, Graves' disease, Hyperthyroidism |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | Cloverleaf skull syndrome, dermoid cyst, Lowry-MacLean syndrome
Sturge-Weber syndrome, Raine syndrome, Osteodysplasty (Melnick-Needles), Crouzon craniofacial dysostosis, Insulin receptor defect with insulin-resistant diabetes mellitus, Neu-Laxova syndrome, Schinzel-Giedion midface-retraction syndrome, Neuroblastoma Neurofibromatosis, Retinoblastoma, Von Recklinghausen's disease |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | orbital cellulitis, endophthalmitis, sinusitis, aspergillosis, mucormycosis |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | Histiocytosis X, nasal type natural killer/T-cell lymphoma, hemangioma, meningioma, neuroblastoma, neurofibromatosis, optic glioma, retinoblastoma, Von Recklinghausen's disease |
| Opthalmologic | orbital inflammatory pseudotumor, orbital mass, corneal ulcer, Pseudoproptosis |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | Churg-Strauss syndrome, Wegener granulomatosis |
| Renal / Electrolyte | Wegener granulomatosis |
| Rheum / Immune / Allergy | graves' disease, polyarteritis nodosa, wegener granulomatosis, *churg-Strauss syndrome, Relapsing polychondritis, Wegener granulomatosis |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Diagnosis
History and Symptoms
- Includes:
Physical Examination
Appearance of the Patient
Eyes
- full optomologic exam
Ear Nose and Throat
- full otolaryngologic exam
Neurologic
- full neurologic exam
Laboratory Findings
- Labs include
MRI and CT
- CT of orbits
Echocardiography or Ultrasound
- Ultrasound if arteriovenous malformation is suspected
Treatment
Acute Pharmacotherapies
- Direct IV antibiotics -> if infectious
- Systemic steroids -> if non infectious
Surgery and Device Based Therapy
Indications for Surgery
- Surgical decompression
Primary Prevention
- Prevent eye injury
- artificial tears
- eye protection (sunglasses)
See also
References
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
- ↑ Owen Epstein, David Perkin, John Cookson, David P de Bono (2003). Clinical examination (3rd edition ed.). St. Louis: Mosby. ISBN 0-7234-3229-5. Unknown parameter
|month=ignored (help)