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| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{DiseaseDisorder infobox | | | {{DiseaseDisorder infobox | |
| Name = Exophthalmos | | | Name = Exophthalmos | |
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| OMIM = | | | OMIM = | |
| MedlinePlus = 003033 | | | MedlinePlus = 003033 | |
| eMedicineSubj = oph | | | eMedicineSubj = | |
| eMedicineTopic = 616 | | | eMedicineTopic = | |
| DiseasesDB = 18612 | | | DiseasesDB = 18612 | |
| }} | | }} |
| {{SI}} | | {{Exophthalmos}} |
| {{CMG}} | | {{CMG}}; {{JFS}} |
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| {{JFS}} | | {{SK}} Proptosis ; Bulging eyes |
| | ==[[Exophthalmos overview|Overview]]== |
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| __NOTOC__
| | ==[[Exophthalmos historical perspective|Historical Perspective]]== |
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| ==Overview== | | ==[[Exophthalmos pathophysiology|Pathophysiology]]== |
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| '''Exophthalmos''' is a bulging of the [[eye]] anteriorly out of the [[orbit (anatomy)|orbit]]. Exophthalmos can be either bilateral (as is often seen in [[Graves-Basedow disease|Grave's Disease]]) or unilateral (as is often seen in an orbital tumor). Measurement of the degree of exophthalmos is performed using an exophthalmometer. Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma.
| | ==[[Exophthalmos causes|Causes]]== |
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| In the case of Graves Disease, the displacement of the eye is due to abnormal connective tissue deposition in the orbit and extraocular muscles which can be visualized by [[Computed axial tomography|CT]] or [[MRI]].<ref>{{cite book | author = Owen Epstein, David Perkin, John Cookson, David P de Bono | title = Clinical examination | edition=3rd edition | publisher = Mosby | location = St. Louis | year = 2003 | month=April | id = ISBN 0-7234-3229-5 }}</ref>
| | ==[[Exophthalmos differential diagnosis|Differentiating Exophthalmos from other Diseases]]== |
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| If left untreated, exophthalmos can causes the eye lids to fail to close during sleep leading to [[cornea|corneal]] damage. The process that is causing the displacement of the eye may also compress the [[optic nerve]] or [[ophthalmic artery]] leading to [[blindness]].
| | ==[[Exophthalmos epidemiology and demographics|Epidemiology and Demographics]]== |
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| *A "bulging" of the eye due to foreward displacement. Some sources define exophthalmos as a protrusion of the globe greater than 18 mm and proptosis as a protusion equal to or less than 18 mm. (Epstein et al, 2003). Others define "exophthalmos" as protusion secondary to endocrine dysfunction and "proptosis" as any non-endocrine-mediated protusion.
| | ==[[Exophthalmos risk factors|Risk Factors]]== |
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| | ==[[Exophthalmos screening|Screening]]== |
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| <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| | ==[[Exophthalmos natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ===Complete Differential Diagnosis of the Causes of Exophthalamus === | | == Diagnosis == |
| (In alphabetical order)
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| *[[Arteriorvenous malformation]]
| | [[Exophthalmos history and symptoms| History and Symptoms]] | [[Exophthalmos physical examination | Physical Examination]] | [[Exophthalmos laboratory findings | Laboratory Findings]] | [[Exophthalmos CT|CT]] | [[Exophthalmos MRI|MRI]] | [[Exophthalmos ultrasound|Ultrasound]] | [[Exophthalmos other diagnostic studies|Other Diagnostic Studies]] |
| *[[Aspergillosis]] (invasive, orbital)
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| *[[Basedow syndrome]] (combination of hyperthyroidism, goitre, and exophthalmos )
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| *[[Boston's sign]] (spasmodic lowering of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter)
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| *[[Carotid-cavernous fistula]]
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| *[[Cavernous Sinus Thrombosis]]
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| *[[Churg-Strauss syndrome]]
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| *[[Cloverleaf skull syndrome]]
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| *[[Cole-Carpenter syndrome]]
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| *[[Corneal ulcer]]
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| *[[Crouzon craniofacial dysostosis]]
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| *[[Dalrymple's sign]]
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| *[[Dermoid cyst]]
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| *[[Endophthalmitis]]
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| *[[Erdheim-Chester disease]]
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| *[[Graves' disease]]
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| *[[Hemangioma]]
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| *[[Histiocytosis X]]
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| *[[Hyperthyroidism]]
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| *[[Infiltrative ophthalmopathy]]
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| *Insulin receptor defect with insulin-resistant diabetes mellitus
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| *[[Lowry-MacLean syndrome]]
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| *[[Meningioma]]
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| *[[Mucormycosis]]
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| *Nasal type natural killer/T-cell [[lymphoma]]
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| *[[Neu-Laxova syndrome]]
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| *[[Neuroblastoma]]
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| *[[Neurofibromatosis]]
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| *[[Optic glioma]]
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| *Orbital [[cellulitis]]
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| *[[Orbital inflammatory pseudotumor]]
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| *Orbital mass or tumors
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| *Osteodysplasty (Melnick-Needles)
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| *[[Polyarteritis nodosa]]
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| *[[Pseudoproptosis]] (buphthalmos, contralateral enophthalmos
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| ipsilateral lid retraction, axial myopia, contralateral blepharoptosis)
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| *[[Raine syndrome]]
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| *[[Relapsing polychondritis]]
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| *[[Retinoblastoma]]
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| *Schinzel-Giedion midface-retraction syndrome
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| *[[Sinusitis]]
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| *Stellwag's sign (infrequent or incomplete blinking associated with exophthalmos or Graves orbitopathy)
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| *Sturge-Weber syndrome
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| *TAO (Thyroid associated orbitopathy)
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| *[[Tolosa-Hunt syndrome]]
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| *Trauma
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| *Von Graefe's sign (immobility or lagging of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter)
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| *[[Von Recklinghausen's disease]] (Neurofibromatosis)
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| *[[Wegener granulomatosis]]
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| | | ==Treatment== |
| | | [[Exophthalmos medical therapy|Medical Therapy]] | [[Exophthalmos surgery|Surgery]] | [[Exophthalmos primary prevention|Primary Prevention]] | [[Exophthalmos secondary prevention|Secondary Prevention]] | [[Exophthalmos cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Exophthalmos future or investigational therapies|Future or Investigational Therapies]] |
| Make sure that each diagnosis is linked to a page.
| | ==Case Studies== |
| | | [[Exophthalmos case study one|Case #1]] |
| ===Complete Differential Diagnosis of the Causes of ...=== | | ==Related Chapters== |
| (By organ system)
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| {|style="width:75%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |Carotid-cavernous fistula
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| Cavernous sinus thrombosis, Tolosa-Hunt syndrome, [[Hemangioma]]
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| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| Orbital inflammatory pseudotumor, Orbital mass, [[Sinusitis]]
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| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| [[Basedow syndrome]], [[Graves' disease]], [[Hyperthyroidism]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic''' | |
| |bgcolor="Beige"| Cloverleaf skull syndrome, dermoid cyst, Lowry-MacLean syndrome
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| Sturge-Weber syndrome, Raine syndrome, Osteodysplasty (Melnick-Needles), Crouzon craniofacial dysostosis, Insulin receptor defect with insulin-resistant diabetes mellitus,
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| Neu-Laxova syndrome, Schinzel-Giedion midface-retraction syndrome, [[Neuroblastoma]]
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| [[Neurofibromatosis]], [[Retinoblastoma]], [[Von Recklinghausen's disease]]
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| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| orbital cellulitis, endophthalmitis, sinusitis, [[Aspergillosis]], [[Mucormycosis]]
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue" | |
| | '''Oncologic'''
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| |bgcolor="Beige"| Histiocytosis X, nasal type natural killer/T-cell lymphoma, [[Hemangioma]], [[Meningioma]], [[Neuroblastoma]], [[Neurofibromatosis]], [[Optic glioma]],[[Retinoblastoma]], [[Von Recklinghausen's disease]]
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| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| Orbital inflammatory pseudotumor, Orbital mass, [[Corneal ulcer]], [[Pseudoproptosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| [[Churg-Strauss syndrome]], [[Wegener granulomatosis]]
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| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"|[[Wegener granulomatosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[graves' disease]], [[polyarteritis nodosa]], [[wegener granulomatosis]], *[[churg-Strauss syndrome]], [[Relapsing polychondritis]], [[Wegener granulomatosis]]
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| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |}
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| == Diagnosis ==
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| === History and Symptoms ===
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| *Includes:
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| :*age
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| :*rate of onset
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| :*[[pain]]
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| :*[[fever]]
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| :*[[diplopia]]
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| :*[[thyroid disease]]
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| :*[[sinusitis]]
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| :*[[diabetes]]
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| :*[[cancer]]
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| === Physical Examination ===
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| === Appearance of the Patient ===
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| === Eyes ===
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| *full optomologic exam
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| === Ear Nose and Throat ===
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| *full otolaryngologic exam
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| === Neurologic ===
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| *full neurologic exam
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| == Laboratory Findings == | |
| *Labs include
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| :*[[thyroid function tests]]
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| :*[[ESR]]
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| :*[[CRP]]
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| :*[[CBC]]
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| :*[[ANCA]]
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| :*[[ANA]]
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| :*[[Blood culture]]
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| === MRI and CT ===
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| *[[CT]] of orbits
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| === Echocardiography or Ultrasound ===
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| *[[Ultrasound]] if [[arteriovenous malformation]] is suspected
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| == Treatment ==
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| === Acute Pharmacotherapies ===
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| *Direct IV antibiotics -> if infectious
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| *Systemic steroids -> if non infectious
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| == Surgery and Device Based Therapy ==
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| === Indications for Surgery ===
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| *Surgical decompression
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| == Primary Prevention ==
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| *Prevent eye injury
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| *artificial tears
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| *eye protection (sunglasses)
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| ==See also== | |
| *[[Boston's sign]] | | *[[Boston's sign]] |
| *[[Enophthalmos]] | | *[[Enophthalmos]] |
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| *[[Graves ophthalmopathy]] | | *[[Graves ophthalmopathy]] |
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| == References ==
| | [[Category:Medical signs]] |
| {{Reflist}}
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| {{Eye pathology}}
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| {{SIB}}
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| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Physical Examination]] | | [[Category:Physical Examination]] |
| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
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| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |