Proptosis

Introduction Eyeball protrusion means that the eyeball is out of the normal range. The normal eyeball protrusion of Chinese people is 12-14m, with an average of 13mm, and the difference between the two eyes is no more than 2mm. Eyeballs can be signs of eye disease or symptoms of systemic diseases. In addition to the lesions in the sputum, it is often closely related to diseases of internal medicine, otolaryngology, neurosurgery, and oncology. Inflammation of the eyelids, edema, tumor or trauma, cavernous sinus thrombosis or enlarged eyeballs (such as congenital glaucoma and One-sided high myopia can cause one eye or two eyes to protrude.

Cause

Orbital edema and lymphatic infiltration during hyperthyroidism can cause unilateral or bilateral ocular protrusion. Sudden unilateral ocular protrusion is usually caused by bleeding or inflammation of the eyelid or paranasal sinus. Those who occurred 2 to 3 weeks were caused by chronic inflammation or eyelid pseudotumor (non-neoplastic cell infiltration and hyperplasia), and chronic diseases were caused by new organisms.

Arteriovenous tumors of the internal carotid artery and cavernous sinus can cause pulsatile eyeballs with murmur. The occurrence of trauma may be due to carotid-cavernous sinus fistula, which can be confirmed by eye auscultation. Trauma or infection (especially the face) can cause cavernous sinus thrombosis with unilateral ocular protrusion and fever. Unilateral high myopia or meningioma can cause unilateral ocular protrusion.

an examination

Related inspection

Hertel's eyeballs eyeball and eyelid examination ophthalmology eye function examination

Physical examination:

A full physical examination is very important. The endocrine and blood system that can cause eyeballs should be examined. Pay attention to the presence or absence of inflammation and mass in the paranasal sinus, and whether there are other primary tumors.

Eye examination: pay attention to vision, measure the width of the cleft palate, whether the gingival margin is smooth, whether there is a lump around the periorbital, whether the eyelids and conjunctiva are swollen or congested, and the eye movement. Measurement of eyeball protrusion, eye movement, prominent direction, presence or absence of pulsation, relationship with body position, presence or absence of noise. The texture of the elastic mass may be cysts, hemangioma, meningeal bulging. Harder cancer and more opportunities for pseudotumor. The medial mass is mostly mucous cyst, and the outer mass should consider lacrimal gland tumor and dermoid cyst. When the eyeball protrudes early, there is a central visual impairment, and the chance of glioma, meningioma, neurofibromatosis, and sphenoid sinus cyst is large.

Laboratory inspection:

Thyroid function tests help identify endocrine ocular protrusions. Serum thyroxine (T4), triiodothyronine (T3), and thyrotropin (TSH) should be measured.

Blood examinations include peripheral blood and bone marrow examinations, mass punctures or biopsies.

Differential diagnosis

Differential diagnosis:

(A) eyelid cellulitis: is an acute inflammation of the soft tissue or subperiosteal. Due to the close relationship between the ankle and the cranial cavity and the eyeball, permanent visual impairment and intracranial complications can be caused. It is caused by the spread of infections in adjacent tissues or from traumatic infections. Clinical manifestations include ocular protrusion and dyskinesia. There are redness and swelling of the eyelids, conjunctival congestion and edema, and there may be congestion, edema and retinal edema in the fundus. In severe cases, the body temperature increases and the white blood cells increase. Due to the reflection of the heart, a relatively slow pulse may occur. Inflammation in the sac can be formed by cavernous sinus embolization through the supracondylar venous and cavernous sinus. The performance of the eye is similar to that of cellulitis, but it is more serious than the symptoms of cellulitis, and it quickly spreads to the contralateral side. Symptoms such as headache, irritability, paralysis, convulsions, and coma occur. In addition to eyeballs, some malignant tumors in the orbit may also have redness and swelling of the eyelids and limited movement of the eyeballs, which is difficult to distinguish from cellulitis. Therefore, attention should be paid to medical history and physical examination. Imaging examination can help diagnose.

(B) inflammatory pseudotumor: is one of the common reasons for monocular eyeball protrusion. Because of the symptoms of the tumor, but in essence is non-specific chronic proliferative inflammation in the sputum, it is called inflammatory pseudotumor. The cause is unknown, clinical manifestations: there is a history of eyelid swelling, only a few weeks or months to find eyeballs or eyelid mass.

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