By Kevin Joseph Ambadan

*Proptosis

Forward displacement of eyeball beyond the orbital margins.

Exophthalmos is synonymous, but used for the displacement associated with thyroid d/s.

*Definition

*Classification

*U/l proptosis

*Bilateral proptosis

*A/c proptosis

*Intermittent proptosis

*Pulsating proptosis

*Etiology

*Unilateral Proptosis• Congenital: dermoid cyst

congenital cystic eyeball

orbital teratoma

• Traumatic: orbital hemorrhage

retained intraorbital FB

traumatic aneurysm

emphysema of orbit

• Inflammatory Lesions: A/c: orbital cellulitis

abscess

panophthalmitis

thrombophlebitis

cavernous sinus thrombosis

C/c: pseudotumours

tuberculoma

gumma

sarcoidosis

• Circulatory Disturbances & Vascular Lesions:

angioneurotic edema

orbital varix

aneurysms

• Cysts of orbit: hematic cyst

implantation cyst

parasitic cyst (hydatid cyst & cysticercus cellulosae)

• Tumors: primary, secondary or metastatic

• Mucocele of PNS: frontal(most common), ethmoidal, maxillary sinuses

*Bilateral Proptosis• Developmental Anomalies of Skull:

craniofacial dysostosis (oxycephaly(tower skull))

• Osteopathies: osteitis deformans

rickets

acromegaly

• Inflammatory Conditions: Mikulicz’s syndrome

late stage of cavernous sinus

thrombosis

• Endocrinal Exophthalmos: thyrotoxic or thyrotropic.

• Tumors: symmetrical lymphoma or

lymphosarcoma secondaries from neuroblastoma

Ewing’s sarcoma

leukemic infiltration

• Systemic Disease: histiocytosis

systemic amyloidosis

Wegener’s granulomatosis.

*Acute Proptosis Develops with extremely sudden onset.

•Common Causes orbital emphysema

fracture of medial orbital wall

orbital hemorrhage

rupture of ethmoidal mucocele

*Intermittent Proptosis Appears & disappears on its own.

•Common Causes: periodic orbital edema

orbital varix

recurrent orbital hemorrhage

highly vascular tumors

*Pulsating Proptosis

•Causes:

1. Pulsating vascular lesions (caroticocavernous fistula and saccular

aneurysm of ophthalmic artery)

2. Transmitted cerebral pulsations associated with deficient orbital roof

(congenital meningocele or meningoencephalocele, neurofibromatosis, traumatic or operative hiatus)

*The End