Exophthalmos
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Overview
Exophthalmos is a bulging of the eye anteriorly out of the orbit. 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.[1]
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.
- A "bulging" of the eye due to foreward displacement. 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.
- Common in Grave's Disease patients
- Causes
- inflammatory
- infectious
- neoplastic
- traumatic
- vascular
- Sight can be compromised
- Imaging is essential for all patients
Differential Diagnosis
- Arteriorvenous malformation
- Cavernous Sinus Thrombosis
- Mucormycosis
- Neurofibromatosis
- Orbital cellulitis
- Orbital tumors
- Pseudoproptosis
- TAO (Thyroid associated orbitopathy)
- Trauma [2] [3]
Complete Differential Diagnosis of the Causes of Exophthalamus
(In alphabetical order)
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 |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | Cloverleaf skull syndrome
Dermoid cyst Lowry-MacLean syndrome Sturge-Weber syndrome Osteodysplasty (Melnick-Needles) Crouzon craniofacial dysostosis Insulin receptor defect with insulin-resistant diabetes mellitus Neu-Laxova syndrome Schinzel-Giedion midface-retraction syndrome |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | Orbital cellulitis
Endophthalmitis Sinusitis |
| 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 |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | Graves' disease
Polyarteritis nodosa 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
- ↑ 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) - ↑ 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