When one eye seems to bulge forward, the doctor might have a serious problem on his hands and the following likely causes should be considered:
• Pseudoproptosis. An apparent bulging forward of the eye occurs if the eye is too big, as in unilateral high myopia, or if the other eye is sunken following a blow-out fracture of the maxilla (orbital floor). These need to be distinguished from a true proptosis.
• Thyrotoxicosis. This is the commonest cause of unilateral or bilateral proptosis; diagnosis is achieved from the history, examination and tests of thyroid function (Figure 15.11).
• Infection. Orbital cellulitis, usually from neighbouring sinuses, requires urgent otorhinological opinion.
• Trauma. Proptosis can occur as a result of retro-orbital haemorrhage. Diagnosis should be possible from the patient's history.
• Haemangioma. This can expand after bending down or crying. Ultrasound and CT scanning can confirm the diagnosis. Occasionally, angiography might be required.
• Pseudotumour. Biopsy should be carried out if possible, and other causes excluded.
• Mucocele of sinuses. Diagnose by X-ray or CT scan.
• Lymphoproliferative disease. A biopsy, full blood count and sternal marrow puncture should be carried out.
Table 15.2. Causes of proptosis.
• Vascular abnormalities
• Inflammatory disorders
• Primary orbital tumours
• Others. There are a large number of possible but rare causes of proptosis.
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