Proptosis or exophthalmos:
- Many types, i.e. bilateral, symmetric and central or it may be eccentrically rather than centrally displaced. Usually caused by
- Tumors or masses or seen in people with shallow orbits.
- Some congenital anomalies, microphthalmia, cryptophthalamia.
- Vascular diseases: orbital edema, orbital hemorrhage ➔ intermittent and pulsating exophthalmos.
- Measured by Exophthalmometry
Orbital Inflammation:
Usually caused by adjacent inflammation of the sinuses or Inflammation from rest of the body.
Orbital cellulitis vs septal inflammation: In septal inflammation, visual acuity is not affected, in cellulitis, however, visual acuity is affected and it’s a medical emergency as it can infect the brain and the cranial nerves.
Orbital cellulitis may be caused by penetrating trauma. An emergency in children as the infection can spread very rapidly.
Parasitic diseases of the Orbit.
Extremely rare, worms in the orbit. A tropical disease found in south east asia mainly, eating pork main cause
Endocrine associated Orbital disease: Thyrotoxic Exophthalmos, Dalrimple sign,
Stellwag’s SIGN,
Antibodies against thyroid gland also attack the fat tissue in the orbit → degeneration of fat tissue➔ eyes popping out as its no longer held in place.
Malignant Exophthalmos (Thyrotoxic exophthalmos): complication = inability of the eye lid to close
Orbital Tumors:
Dermoid cyst of the eye
Hemangioma- may subside with age but rarely require treatment with steroids and surgery
Rhabdomyosarcoma: little pain or redness and no fever, suspect malignancies. Must be surgically treated.
Orbital Trauma:
Blow out fracture: indirect pressure as the energy is transmitted by the eye ball, damaging the inferior orbital wall. Medial wall is elastic therefore easy to break. The muscle becomes trapped between the bone ➔ Diplopia. Surgical trapping of the muscle. Compression and damage to optic and oculomotor nerve therefore eye lid closure, movement of the eyes and visual acuity affected.