Proptosis
Definition And Pathophysiology
- Protrusion of eye, also referred to as exophthalmos.
- Serves as common indicator of underlying orbital disease.
- Results from shallowness of orbits seen in craniofacial malformations.
- Occurs secondary to increased tissue mass within orbit from neoplastic, vascular, or inflammatory disorders.
Clinical Etiology
| Category | Specific Conditions | Key Clinical Features |
|---|---|---|
| Infectious | Orbital cellulitis | Classic triad includes proptosis, painful ophthalmoplegia, and potentially decreased visual acuity. |
| Infectious | Bacterial rhinosinusitis | Orbital extension from ethmoid sinuses causes proptosis alongside diplopia and severe headache. |
| Inflammatory | Nonspecific orbital inflammation | Idiopathic inflammatory process presenting with periorbital edema, pain, and proptosis. |
| Allergic | Allergic fungal sinusitis | Extensive disease expands ethmoid sinuses causing lateral displacement, or frontal sinuses causing inferolateral displacement. |
| Neoplastic | Orbital tumors | Frequent in neurofibromatosis; teratomas exhibit explosive rapid growth and proptosis at birth. |
| Vascular | Carotid-cavernous fistula | Presents with proptosis, diplopia, and characteristic orbital bruit. |
Clinical Evaluation And Signs
- Evaluate for resistance to retroplacement of globe.
- Assess for impairment of extraocular eye movements.
- Palpate for associated orbital mass.
- Note presence of visual loss or optic nerve head congestion.
Severe Complications
- Exposure keratopathy due to inadequate lid closure.
- Ocular motor disturbances and restrictive strabismus.
- Optic atrophy resulting in permanent loss of vision.
Diagnostic Management
- Urgent computed tomography required to confirm orbital or central nervous system involvement.
- Prompt neuroimaging essential when accompanied by vomiting, seizures, or focal neurological deficits.