Proptosis
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