Exophthalmos

 

Exophthalmos is always indicative of orbital pathology. Orbital pyramid constructed with rigid bony walls opens forward and any increase in the content pushes the eyeball forward either in the axis of the orbital cone and exophthalmos is called axial or eccentrically and exophthalmos is said shifted. For example, a tumor of the optic nerve causes axial proptosis, a tumor of the lacrimal gland causes exophthalmos shifted down and off.

Exophthalmos

Exophthalmos

Exophthalmos can be unilateral or bilateral.

The tumors are usually unilateral exophthalmos responsible bilaterality is more the fact of the inflammatory process (90% of Basedowiennes ophthalmopathy are bilateral).

Exophthalmos can be reducible (easily reducible pressure) in the case of dysthyroïdiennes myositis and orbital cellulitis, orirreducible, involving a retro-ocular malignancy.

It can be painless and gradual moving towards a tumor etiology confirmed imaging, or explosive and painful while translating an inflammatory disease, infectious or vascular.

Exophthalmos, throbbing, synchronous heartbeat, usually unilateral, accompanied by conjunctival redness and eye pain, occurring a few days after a head injury, a sign that there is a carotid-cavernous shunt.

Finally, exophthalmia can be observed when constrictions bony orbital such as those observed in the cranio-stenosis and fibrous dysplasia.

Two aspects are often misleading mistakenly viewed as exophthalmia: these are the big myopic eyes and buphtalmies congenital glaucoma.

Exophthalmos is measured using a exophthalmometer Hertel.

The main causes of exophthalmia are:

– Tumors;

– Inflammatory diseases (thyroid dysfunction being the most common);

– Infection.

YOU DIE:

The tumors are manifested by progressive unilateral exophthalmos. Gliomas and meningiomas ducts are the most common tumors of the optic nerve. In children, the optic nerve glioma is observed in one third of cases associated with neurofi bromatose; exophthalmos is usually the first sign of the disease, visual impairment often passing unnoticed in young children. In adults, this tumor is rare and prognosis as formidable as cerebral gliomas.

Meningioma of the optic nerve sheaths usually occurs in women age 50 and gradually causes blindness. The happily slow evolution of these tumors can be slowed by radiation therapy.

Lymphoma, metastases, tumors of the lacrimal gland, vascular tumors (capillary hemangioma, cavernous hemangioma) are the most frequent expansive processes.

After 60 years, malignant tumors are the leading cause of tumors of the orbit.

INFLAMMATORY DISEASES:

Graves’ disease:

The orbitofrontal dysthyroid ophthalmopathy is an inflammation of the connective tissue, specifically the orbital fibroblast, target of thyroid antibodies abnormally products in hyperthyroidism.

30 to 40% are associated with hyperthyroidism ophthalmopathy, in bilateral general.

This translates clinically exophthalmos and upper eyelid retraction bilateral, revealing association of thyroid dysfunction.

The orbit is not extensible, the increase in size of the eye muscles (up to 8 times the volume) pushes forward the globe. The precise imaging the existence of big eye muscles, proptosis figure, and displays the orbital apex, the seat of the optic nerve compressions, major complications of ophthalmopathy.

The severity of the ophthalmopathy dysthyroid stems therapeutic strategy.

The scalability of the orbital disease is unpredictable, nothing originally to screen a severe form progresses to optic nerve compression. This complication requires urgent orbital decompression.

In other cases, is discussed orbital radiotherapy or corticosteroids.

When the disease goes off, restorative orbitofrontal eyelid surgery is an excellent therapeutic response to disfigurement of these patients disfigured by this orbitopathy (female, mean age 43 years).

Subacute or chronic inflammation orbital (formerly orbital pseudotumor):

This chapter contains all orbitopathies infl ammatory non thyroid: those associated with sarcoidosis, lupus, Lyme disease, Wegener; this is in elimination diagnoses after comprehensive etiological investigations, CT, MRI, ultrasound, orbital biopsies.

INFECTIONS:

Orbital cellulitis:

This orbital pathology results in the rapid installation of a unilateral exophthalmos, painful, with conjunctival redness, chemosis, limiting the excursion of the globe and ptosis. The febrile context, the existence of sinusitis (ethmoiditis common in children), the possibility of an intracranial spread of infection are the seriousness of the orbitopathy.

Mucormycosis:

Fungal infection orbital evolution often fulminant, it occurs in immunocompromised patients and its prognosis is very serious.

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