Proptosis: Difference between revisions
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==Background== | ==Background== | ||
*Forward displacement of the eye | *Forward displacement of the eye | ||
*Can be bilateral as in Graves disease | *Can be bilateral as in Graves disease | ||
==Clinical Features== | |||
[[File:Proptosis 2014-10-28 12-32.jpg|thumb|Proptosis in a woman with retrobulbar [[abscess]] and orbital cellulitis]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Graves' disease]] (bilateral) | *[[Graves' disease]] (bilateral) | ||
*[[Cavernous sinus thrombosis]] | *[[Cavernous sinus thrombosis]] | ||
* | *[[Carotid-cavernous fistula]] | ||
*[[Orbital cellulitis]] | *[[Orbital cellulitis]] | ||
*[[Mucormycosis]] | *[[Mucormycosis]] | ||
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*[[Orbital hematoma]] | *[[Orbital hematoma]] | ||
== | {{Periorbital swelling DDX}} | ||
==Evaluation== | |||
*Clinical exam ([[Eye Exam]]) | *Clinical exam ([[Eye Exam]]) | ||
**PERRL, EOMI, visual fields | **PERRL, EOMI, [[visual field testing|visual fields]] | ||
**Assess for diplopia | **Assess for [[diplopia]] | ||
**Visual acuity | **Visual acuity | ||
**Intraocular pressure measurement ([[Tono- | **Intraocular pressure measurement (see [[Tono-Pen use]]) | ||
*CT with maxillofacial cuts | *[[head CT|CT]] with maxillofacial cuts | ||
*Consider CTA or MRI/MRV | *Consider CTA or [[brain MRI|MRI]]/MRV | ||
==Management== | ==Management== | ||
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==See Also== | ==See Also== | ||
*[[Lateral Canthotomy]] | *[[Lateral Canthotomy]] | ||
*[[Globe luxation reduction]] | |||
==References== | ==References== | ||
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[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
[[Category:Symptoms]] | |||
Latest revision as of 21:35, 26 September 2020
Background
- Forward displacement of the eye
- Can be bilateral as in Graves disease
Clinical Features
Proptosis in a woman with retrobulbar abscess and orbital cellulitis
Differential Diagnosis
- Graves' disease (bilateral)
- Cavernous sinus thrombosis
- Carotid-cavernous fistula
- Orbital cellulitis
- Mucormycosis
- Orbital fractures
- Orbital hematoma
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Evaluation
- Clinical exam (Eye Exam)
- PERRL, EOMI, visual fields
- Assess for diplopia
- Visual acuity
- Intraocular pressure measurement (see Tono-Pen use)
- CT with maxillofacial cuts
- Consider CTA or MRI/MRV
Management
- Management depends of pathophysiology
- Increased IOP may require a lateral Canthotomy