A study of unilateral proptosis

Santhi, P (2006) A study of unilateral proptosis. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: The orbit houses the eyeball and subserves the major functions of protection of the eye and facilitates extreme degree of motility possible by the eye. The orbit is pear shaped cavity, the stalk of which is the optic canal. The orbital diseases gain importance due to involvement of optic nerve hence causing decreased vision. The intraorbital portion of optic nerve is longer (25mm) than the distance between, the back of the globe and optic canal (18mm). This allows for significant forward displacement of the globe (i.e) proptosis. Clinically given case of unilateral proptosis is challenging even for experienced ophthalmologist with special interest in orbital diseases. Since orbit is in close relation to paranasal sinus, maxilla and cranium, primary diseases of these areas may initially present as proptosis. Hence a detailed study of, age of occurance of disease, findings on examination, progression of disease, available incidence of such disease, investigation results, become essential to diagnose a case of proptosis. Proptosis is the hall mark of orbital diseases. Prompt and early diagnosis becomes essential as this socket, a small space in between orbital wall will lead to increased damage than one expects, and removal of masses will become difficult in later stages. In unilateral proptosis cosmetic disfigurement becomes alarming to patients. Hence a detailed study of unilateral proptosis is necessary to find the diagnosis as early as possible so as to save the globe for cosmetic appearance and more than that to restore vision to its maximum possible limits. This study aims to evaluate in detail variations in incidence, age group involved, etiology, methods of investigation and treatment offered to patients, and the results obtained. AIM OF THE STUDY: 1. Demographic study of unilateral proptosis 2. Incidence of various causes of unilateral proptosis 3. Effect on vision and visual recovery following treatment 4. Cure rate possible in various etiological causes. 5. Analyzing the significance of clinical symptoms signs and directing appropriate laboratory imaging investigation 6. Influence of patients age on diagnosis consideration. MATERIALS AND METHODS All the patients were selected form the orbit clinic of the Department of Ophthalmology. Govt. Rajaji Hospital, Madurai Each patient was thoroughly examined in the same department. After recording the detailed history including past history , general and ocular examination were carried out. Exophthalmometry was done for all cases. Detailed examination of the proptosis was done to know whether it is axial or eccentric, its reducibility, pulsatility, tenderness, thrill, bruit, presence of visible mass and change associated with cough impulse and valsalva maneouvre. Investigations like total count, differential count, urine sugar, peripheral smear, VDRL and mantoux test, were done in our department laboratory. Xrays, CT scan and MRI were done in the radiology department.T3, T4 and TSH estimation were done in the endocrinology department. Doppler study was done for two patients soutside. Lateral and medial orbitotomies were done for appropriate lesions. Cases were followed up in the eye department. All the findings were entered in a proforma for further analysis. Cases of trauma that presented with unilateral protopsis and pseudoproptosis cases were excluded from the study. SUMMARY: The literature on unilateral proptosis is reviewed. Materials and methods employed are stated. Sixty cases were studied out of whom 29 were males and 31 were females. Unilateral proptosis was the presenting feature in 5.55% of all the orbit clinic patients. Unilateral proptosis was five times more common than bilateral proptosis. Defective vision was the commonest associated symptom, which was present in 82% of the patients with unilateral proptosis. Pain was associated with 41.8 % of cases and Diplopia was present is only 10% of cases. Right eye was more commonly involved than the left eye. Eccentric proptosis was more common than axial proptosis. Irreversible optic nerve damage resulted in 11.62% patients. Inflammation was the commonest aetiology found in adults 38.18%. Thyroid opthalmopathy comes next with 25%. Neoplasm was 11.62%. 100% cure rate was achieved in vascular lesions. Prognosis was second best in inflammatory lesions. The cure rate being 85%. Children responded better than adults to treatment. Complete visual recovery was attained with vascular lesions after surgery. Visual recovery in inflammatory lesions was 73%. Primary orbital pathology responded well to treatment than secondary involvement. Biopsy was found to be an useful adjunct to x- rays and CT scan. CONCLUSION: In Conclusion orbital disease offers clinicians a challenging field in which to pursue diagnostic, medical, and surgical modalities. Inflammatory orbital disease accounts for leading cause of orbital disorders followed by thyroid ophthalmopathy. Neurogenic, and vascular mass lesions are the common tumor subdivisions in both adults and children. Fortunately, orbital mass lesions are benign in majority of cases, but life-threatening malignancy must always be considered.

Item Type: Thesis (Masters)
Uncontrolled Keywords: unilateral proptosis
Subjects: MEDICAL > Ophthalmology
Depositing User: Devi S
Date Deposited: 27 Sep 2017 11:59
Last Modified: 27 Sep 2017 11:59
URI: http://repository-tnmgrmu.ac.in/id/eprint/3415

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