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COMMON CAUSES OF PROPTOSIS

COMMON CAUSES OF PROPTOSIS. What is proptosis ?. Abnormal protrusion of the eyeball. Exophthalmos : same as above but usually used in relation to endocrinopathies such as thyroid related proptosis . Pathophysiology.

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COMMON CAUSES OF PROPTOSIS

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  1. COMMON CAUSES OF PROPTOSIS

  2. What is proptosis? • Abnormal protrusion of the eyeball. • Exophthalmos : same as above but usually used in relation to endocrinopathies such as thyroid related proptosis.

  3. Pathophysiology • The basic pathophysiology irrespective of the aetiology is an increase in volume of the orbital content within the fixed bony orbital confines. • The orbit is widest anteriorly and not enclosed so the contents are displaced anteriorly resulting in proptosis.

  4. Anatomy of the Orbit • A Pear shaped cavity with the optic canal as the stalk. • Has 4 parts: • Roof: • Formed by the lesser wing of sphenoid and frontal bones. Subjacent to the anterior cranial fossa and frontal sinus. • Any defect may lead to a pulsatileproptosis.

  5. Lateral wall • Formed by greater wing of sphenoid and zygomatic bones. • Protects only the posterior half of the globe. • Anterior half is vulnerable to lateral trauma. • Floor: • Consists of zygomatic, maxillary and palatine bones. • Forms the roof of the maxillary sinus.

  6. Contd.. • Maxillary carcinoma may invade the orbit displacing the globe upwards. • The posterior medial portion is weak predisposing it to blow out fractures. • Medial Wall: • Consists of 4 bones: maxillary, lacrimal, ethmoid, and sphenoid. • Has very thin lamina papyracea covering the medial wall and perforated by foramina for nerves and blood vessels. Therefore predisposed to orbital cellulitis secondary to ethmoidal sinusitis.

  7. Importance of proptosis • Visual Threatening: exposure keratopathy, compressive optic neuropathy. • Life Threatening: malignant tumors. • Cosmetic implications

  8. Causes of Proptosis • Primary orbital pathology. • Secondary to systemic diseases.

  9. Contd... • Vascular: Orbital Varices, carotid cavernous fistula. • Inflammatory: Thyroid orbitopathy • Trauma: orbital haemorrhage, fractures • Aneurysm(CYSTIC LESIONS): dermoid cyst, encephlocele, mucocele. • Miscellaneous: Leukaemia, lymphoma, rhabdomyosarcoma, metastatic Ca. • Infection: Orbital Cellulitis • Neoplasm: Lacrimalpleomorphic adenoma optic nerve glioma, optic nerve sheath meningioma.

  10. Clinical features • Symptoms depends on the cause: • Pain in inflammatory causes • Rapidly progressing protrusion in acute causes. • Poor vision from corneal lesions or optic nerve compression. • Restricted globe movement from extraocular muscle contraction as in thyroid eye disease.

  11. Clinical Evaluation • Ocular: • Visual Acuity • Colour vision • Pupillary reflex • Extent of globe displacement using an exophthalmometer. • Globe retropulsion • Eyelid position

  12. Examination contd... • Pulsation or thrill • Bruit on auscultation. • Cranial nerves. • Regional lymph nodes • Nasal • Thyroid • Breast • Prostate

  13. Investigation • Radiological: • Plain x-ray: Caldwell view detects orbital lesion. Waters view, detects orbital floor fractures. • CT-scan: useful in locating and detecting SOL, in detecting FB, blood, emphysema.depicts bony structure. Doesn’t differentate radiological isodense tissue masses. • MRI: Can image orbital apex lesions and intracranial extensions. Not good with bony lesions

  14. Haematological • WBC: total and differentials • Blood culture • Microbiology • Lumbar puncture for mcs • Conjunctival swab for mcs • Fine needle aspiration biopsy

  15. Treatment • Depends on the cause: • Medical: • Antibiotics : topical and systemic for infective causes. • Chemotherapy for malignancies. • Surgical: • Excision • Interventional radiology with intravascular balloons introduced via a catheter to close the internal carotid artery fistula in CCF.

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