Exophthalmos

Introduction About half of people with exophthalmos have different degrees of eyeball protrusion, mostly symmetry and unilateral patients often have a frightened expression, widened eye cracks, two eyes straight, and fewer blinks, which constitute a face of thyroid gland.

Cause

There are two special eye signs for exophthalmia:

1, non-wetting exophthalmos: also known as benign exophthalmos, more common. It is generally symmetrical, and sometimes one side of the eyeball protrudes before the other side, mainly due to sympathetic nerve excitability of the extraocular muscles and upper diaphragm muscle tension.

2, invasive exophthalmos: called malignant exophthalmos, also known as secretory exophthalmos. Less common, the condition is more serious, can be seen in patients with no obvious hyperthyroidism or high metabolic signs.

an examination

Related inspection

Thyroxine (T4) thyroid gland 131 iodine test

Diagnosis of exophthalmia:

1, non-wetting exophthalmos: also known as benign exophthalmos, more common. There are several performances:

(1) Eyelid fissure widening sign

(2) The inner side of the eye cannot be aggregated or poorly

(3) When the eye is looking down, the upper eye is sturdy and can not follow the eyeball

(4) When the eye is looking up, the forehead skin cannot be wrinkled

2, invasive exophthalmos: called malignant exophthalmos, also known as secretory exophthalmos. Less common, the condition is more serious, can be seen in patients with no obvious hyperthyroidism or high metabolic signs. The degree of exophthalmia is often above 19cm, even up to 30cm due to ophthalmoplegia or palsy. Eye movement is limited by diplopia and strabismus. Due to high protrusion, poor eye closure, bulbar conjunctiva and cornea are often exposed, which may cause keratitis. And ulceration, if the treatment is not timely, the disease develops to cause corneal opacity or perforation and even blindness, common patient statements. Often eyeballs are prone to tearing, fear of light, and foreign bodies in the eye.

Differential diagnosis

Identification of exophthalmia:

First, inflammatory eyeballs

(a) eyelid cellulitis

It is the acute inflammation of the soft tissue or subperiosteal in the sputum. Due to the close relationship between the sputum and the cranial cavity and the eyeball, permanent visual impairment and intracranial complications can be caused by the spread of infection of adjacent tissues or traumatic infection. Clinical manifestations include ocular protrusion and dyskinesia with redness and swelling of the eyelids, conjunctival congestion and edema, and fundus edema and retinal edema. In severe cases, the body temperature increases, and the leukocytosis may be relatively slow due to the reflection of the heart. Intraorbital inflammation can form a cavernous sinus embolization through the supracondylar venous and cavernous sinus. Its eye performance is similar to that of cellulitis, but it is more rapid than the side effects of cellulitis. The symptoms of intracranial lesions such as headache, irritability, convulsions, and coma are some of the intracranial malignant tumors except the eyeballs. There may be eyelid swelling, eye movement limitation and sputum cellulitis are difficult to identify. Therefore, attention should be paid to medical history and physical examination. Imaging examination can help diagnose.

(two) inflammatory pseudotumor

It is one of the common causes of monocular eyeball protrusion because of the symptoms of tumor, but it is essentially non-specific chronic proliferative inflammation in the sputum, so the cause of inflammatory pseudotumor is unknown.

Second, neoplastic eyeballs

(a) hemangioma

It is the most common benign tumor in the sputum with a cavernous hemangioma. Most occur in adults, painless chronic progressive ocular protrusion is characterized by more tumors located in the muscle cone, the eyeball is more prominent in front. The disease should be differentiated from intermittent eyeballs. The latter is divided into primary and secondary.

(two) lacrimal gland tumor

It is a common eyelid tumor divided into lacrimal adenocarcinoma and lacrimal adenocarcinoma. The lacrimal gland mixed tumor has a benign and malignant benign account for 80%. More than 35-50 years old. Unilateral morbidity progresses slowly. Most of the early asymptomatic, from the sacral masses located under the eyelids without eyeballs.

(c) Dermoid cyst

One of the most prevalent parts of the eyelid cyst is that the skin is trapped in the embryo during development.

The dermoid cyst should be differentiated from the brain bulge. The latter is the cranial content that protrudes through the defect of the skull and is less common.

(four) meningioma

One third of the patients originated from the sputum or extended from the intracranial meningioma. More common in women, often infringing one side is mostly benign, and occasionally malignant.

(5) Schwannomas

Intrathecal Schwann cell proliferation is more common in adults, mostly benign, mostly from the inside of the muscle cone or the upper part of the iliac crest to make the eyeball protrude straight ahead or the eyeball down. From the motor nerve, early dyskinesia from the sensory nerve, spontaneous pain and tenderness.

(6) Optic glioma

It occurs in 75% of children before the age of 10, and the painless unilateral eyeball protrudes straight ahead. The course of the disease is slow and there is visual impairment before the eyeball protrudes.

(7) Orbital sarcoma

The malignant tumors that occur from the mesoderm are called sarcoma. 65% occur before the age of 20, and the incidence after 40 years old increases again.

(8) Orbital cancer

In addition to the origin of the lacrimal gland, more than the paranasal sinus, eyelid cancer invasion to the eyelids, or from the systemic cancer metastasis to clinical manifestations and imaging examinations are helpful for diagnosis. The primary tumor of metastatic cancer is breast cancer and lung cancer, and the unilateral eyeball is accompanied by diplopia. The history of cancer should be carefully examined to exclude metastatic cancer. 3. Endocrine eyeballs

(a) thyroid toxicity

It is a disease caused by diffuse thyroid enlargement and hyperthyroidism. Occurs in middle-aged women.

(B) thyrotropin-producing eye

Also known as malignant exophthalmos or infiltrative exophthalmos, mostly middle-aged men, both eyes onset.

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