STUDY - Technical - New Dacian's Medicine
Exophthalmos
(proptosis) (Classical / Allopathic Medicine)
Exophthalmos
(proptosis) - the abnormal protrusion of one or both eyeballs
- may result from hemorrhage, edema, or inflammation behind
the eye; extraocular muscle relaxation; or space-occupying
intraorbital lesions and metastatic tumors. This sign may
occur suddenly or gradually, causing mild to dramatic
protrusion. Occasionally, the affected eye also pulsates. The
most common cause of exophthalmos in adults is dysthyroid eye
disease.
Exophthalmos is
usually easily observed. However, lid retraction may mimic
exophthalmos even when the protrusion is absent. Similarly,
ptosis in one eye may make the other eye appear exophthalmic
by comparison. An exophthalmometer can differentiate these
signs by measuring ocular protrusion.
HISTORY:
Ask the patient when he first noticed exophthalmos.
Ask the patient if the exophthalmos is associated with pain in or around the eye. If so, ask him how severe it is and how long he has had it.
Find out if the patient has had a recent sinus infection or vision problems.
Ask the patient when he first noticed exophthalmos.
Ask the patient if the exophthalmos is associated with pain in or around the eye. If so, ask him how severe it is and how long he has had it.
Find out if the patient has had a recent sinus infection or vision problems.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs, noting fever, which may accompany eye infection.
Evaluate the severity of exophthalmos with an exophthalmometer. (See Detecting unilateral exophthalmos.) If the eyes bulge severely, look for cloudiness on the cornea, which may indicate ulcer formation. Describe eye discharge, and look for ptosis. Then check visual acuity, with and without correction, and evaluate extraocular movements.
Take the patient's vital signs, noting fever, which may accompany eye infection.
Evaluate the severity of exophthalmos with an exophthalmometer. (See Detecting unilateral exophthalmos.) If the eyes bulge severely, look for cloudiness on the cornea, which may indicate ulcer formation. Describe eye discharge, and look for ptosis. Then check visual acuity, with and without correction, and evaluate extraocular movements.
Detecting
unilateral exophthalmos
If one of the patient's eyes seems more prominent than the other, examine both eyes from above the patient's head. Look down across his face, gently draw his lids up, and compare the relationship of the corneas to the lower lids. Abnormal protrusion of one eye suggests unilateral exophthalmos. Remember: Don't perform this test if you suspect eye trauma.
SPECIAL CONSIDERATIONS:
Protect the affected eye from trauma, especially drying of the cornea. Never place a gauze pad or other object over the affected eye; removal could damage the corneal epithelium.
If one of the patient's eyes seems more prominent than the other, examine both eyes from above the patient's head. Look down across his face, gently draw his lids up, and compare the relationship of the corneas to the lower lids. Abnormal protrusion of one eye suggests unilateral exophthalmos. Remember: Don't perform this test if you suspect eye trauma.
SPECIAL CONSIDERATIONS:
Protect the affected eye from trauma, especially drying of the cornea. Never place a gauze pad or other object over the affected eye; removal could damage the corneal epithelium.
PEDIATRIC
POINTERS:
In children around age 5, a rare tumor - optic nerve glioma - may cause exophthalmos.
Rhabdomyosarcoma, a more common tumor, usually affects children between ages 4 and 12 and produces rapid onset of exophthalmos.
In children around age 5, a rare tumor - optic nerve glioma - may cause exophthalmos.
Rhabdomyosarcoma, a more common tumor, usually affects children between ages 4 and 12 and produces rapid onset of exophthalmos.
PATIENT
COUNSELING:
Exophthalmos usually makes the patient self-conscious. Provide privacy and emotional support. If necessary, refer him to an ophthalmologist for a complete examination.
Exophthalmos usually makes the patient self-conscious. Provide privacy and emotional support. If necessary, refer him to an ophthalmologist for a complete examination.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)