Causes of Proptosis see Table 152

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

• Metastases

Figure 15.11. Proptosis: dysthyroid disease.03

• Others. There are a large number of possible but rare causes of proptosis.

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