In the clinic, proptosis is best assessed by standing behind the seated patient and asking him to look down. The position of each globe in relation to the lids and face can be best seen by this means. Proptosis can be measured by means of an exophthalmometer. A number of such instruments are on the market and they depend on measuring the distance from the rim of the outer margin of the orbit to the level of the anterior part of the cornea. These measurements are not always accurate (especially for the novice) but best results are achieved by ensuring that they are made by the same person, using the same instrument on each occasion for a given patient.
Once thyroid disease and trauma have been excluded, the patient would require further investigations including systemic examination, full blood picture, orbital ultrasound, CT scan, magnetic resonance imaging (MRI) scan, possibly carotid angiography and sometimes orbital biopsy.
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