proptosis
Introduction
Introduction to eyeballs Eyeball protrusion, also known as a protruding eye, refers to an abnormal state in which the eyeball is displaced forward and protruded. The normal position of the eyeball in the eyelid is that the tip of the cornea does not extend beyond the upper and lower edges of the eyelid. The difference in the degree of protrusion of the eyes is generally not more than 2 mm, otherwise pathological eyeball protrusion should be considered. Sudden unilateral ocular protrusion is usually caused by bleeding or inflammation of the eyelid or paranasal sinus. Those who occurred 2 to 3 weeks were caused by chronic inflammation or eyelid pseudotumor (non-neoplastic cell infiltration and hyperplasia), and chronic diseases were caused by new organisms. The treatment of the disease mainly depends on the etiology. The treatment of arteriovenous tumors should be ligated to the affected common carotid artery. Eyeball protrusion caused by hyperthyroidism may resolve after hyperthyroidism control, and occasionally stubborn cases require eyelid decompression surgery. The exposed cornea must be protected when the eyeball protrudes. The ocular protrusion caused by the thyroid is often exposed keratitis. Systemic application of corticosteroids often helps to control edema and pseudotumor (for example, oral prednisone daily 1mg/kg total 1 Week. Then every other day. For a total of 5 weeks, and then gradually reduced to the minimum dose that can control the eyeball protrusion), the tumor must be removed. basic knowledge The proportion of illness: 0.02% Susceptible people: no special people Mode of infection: non-infectious Complications: conjunctival hyperemia
Cause
Eyeball prominent cause
1 dysplasia: including a variety of orbital developmental lesions.
2 vascular lesions: such as varicose veins, carotid-cavernous sinus fistula.
3 trauma: eyelid burst fracture, foreign body.
4 inflammation: eyelid cellulitis, abscess, orbital inflammatory pseudotumor.
5 tumors: various benign and malignant tumors of the eyelid, common cavernous hemangioma, peripheral nerve tumor, lacrimal gland epithelial tumor.
6 endocrine diseases: thyroid-related eye diseases.
Prevention
Eyeball prevention
There are many causes of eyeball protrusion. Different treatments have different treatment principles. Patients with prominent eyeballs should go to the hospital ophthalmology clinic in time to determine the type and specific cause of eyeball protrusion, and to treat the cause, especially the eyeball caused by trauma. Should be promptly inspected and treated, timely treatment, if the eyeball is not treated, the eyeball will be further prominent, the eyelid closure is not complete to expose keratitis, damage to vision, especially the eyeball caused by malignant tumor, can cause distant metastasis, life-threatening.
Complication
Eyeball complication Conjunctival congestion
Eyeballs are mainly associated with photophobia and tearing, conjunctival hyperemia, elevated intraocular pressure, visual impairment, visual field defects, nausea and vomiting, papilledema, eyelid closure disorders, etc., and different causes of eyeball protrusion, there will be related Complications, such as endocrine, can be accompanied by goiter. Tumor-caused, may invade the brain, causing symptoms related to intracranial metastases, inflammatory infections may lead to intracranial infections, and even serious complications such as sepsis, sepsis.
Symptom
Eyeball prominent symptoms Common symptoms Nausea dizziness Tension tinnitus Recurrent conjunctiva Congestive edema Eyeball retraction Retinal vein distort
1. Inflammatory exophthalmia, eyeball pain and tenderness, dyskinesia, eyelid and conjunctival redness, elevated body temperature; previous history of varying degrees of inflammatory disease.
2. Occupational exophthalmos: caused by orbital tumors. The eyeball is prominently gradual; in the advanced stage, there may be varying degrees of anterior blood stasis in the eye, vision loss, and in some cases, the tumor may touch the mass.
3. Traumatic exophthalmos: a history of trauma or surgery. Acute or subacute ocular protrusion, anterior segmental bleeding, eye movement disorders, etc.
4. Endocrine exophthalmos: refers to thyroid toxic exophthalmos, thyroid stimulating exophthalmos. Frequent bilateral eye disease; eyelid hypertrophy, upper eyelid retraction, cleft palate increased, upper eyelids can not fall with the eyeball in lower vision; blinking movement is reduced, convergence ability is weakened; eye movement is limited to varying degrees, sacral incomplete closure can be combined with exposure Keratitis.
5. Vascular exophthalmos: Mostly unilateral, intermittent and exophthalmic when it is light and heavy, when the head is lowered and the eyeball is highlighted, the eyeball protrusion is reduced or disappeared when standing upright. In the case of pulsatile exophthalmos, the unilateral eyeball pulsates with the pulse, the eye auscultation can smell and pulsating murmur, and when the eyeball or the ipsilateral carotid artery continues to be pressed, the eyeball protrusion decreases or disappears, and the eyelid and the fascia are visible. Blood stasis, edema, retinal vein engorgement, optic disc congestion, edema, vision loss, etc.
Examine
Eyeball examination
ordinary inspection
1. For unexplained unilateral ocular protrusions or bilateral ocular protrusions, thyroid function tests should be performed to rule out hyperthyroidism.
2. If the thyroid function is normal or the eyeball is sudden, the CT scan or MRI of the eye should be used to find the cause of the eye. The degree of eyeball protrusion can be measured by the eyeball.
3. Visual inspection: Determine whether there are problems such as myopia.
4. Blood routine, eye secretion examination: pay attention to whether there is an infectious problem leading to eyeballs.
Auxiliary inspection
1. The examination plan for inflammatory exophthalmos is mainly based on the examination frame "A"; in which inflammatory pseudotumor can be considered for CT examination including "B".
2. The examination plan for space-occupying exophthalmos and traumatic exophthalmos includes B-ultrasound, CT, visual field, etc. in the "A" and "B" of the examination frame, including nuclear magnetic resonance in "C" if necessary.
3. The examination program for endocrine exophthalmos includes examination of the "ECT" in the T3, T4, T3, T4, TSH and "C" in the "A" and "B".
4. The examination plan for vascular exophthalmos includes examination of some of the items in the frame "A" and "B" and the magnetic resonance of "C".
Diagnosis
Eyeball diagnosis and identification
Diagnose based on
1. Inflammatory exophthalmos: caused by inflammation or cavernous sinus infection in the iliac crest, such as cellulitis, periostitis, ocular fasciitis, inflammatory pseudotumor, painful ophthalmoplegia, cavernous sinus thrombosis; Often accompanied by anterior ocular inflammation and ocular dyskinesia.
2. Occupational exophthalmos: mainly caused by primary or secondary tumors in the iliac crest. Ultrasound, CT, and MRI of ophthalmology showed lesions in the sacral space.
3. Traumatic exophthalmos: Mainly caused by fracture of the tibia and fibula caused by traumatic head and face. There are anterior segmental blood stasis, eye movement disorders, etc.; X-ray film, CT examination provides clinical evidence.
4. Endocrine exophthalmos: often eyes, eyelid hypertrophy, upper eyelid retraction, cleft palate increased, lower eyelids can not fall with the eye, lower eye movements, weakening ability of convergence, limited eye movement, thyroid A person with a punctual eye can re-establish it by pressing the eyeball with his hand, and the thyrotropin-producing eye cannot make it. T3, T4, FT3, FT4, TSH and other tests provide clinical basis; B-mode ultrasound and CT examination showed increased fat in the eyelids and hypertrophy of the eye muscles.
5. Vascular exophthalmos intermittent exophthalmos: caused by varicose veins in the orbit. Bowing, hernia, neck twisting or compression of the jugular vein can cause exophthalmos, and when the erect or supine, the exophthalmos disappear. Pulsating exophthalmos: due to the internal carotid artery rupture and the cavernous sinus. Sudden onset, eyeballs pulsate with pulse, eye auscultation can detect pulsating murmurs; when the eyeball or ipsilateral common carotid artery continues to be compressed, eyeball protrusion decreases or disappears; eyelid and bulbar conjunctival sputum, edema; retinal vein engorgement , optic disc congestion, edema, vision loss.
Differential diagnosis
Mainly inflammatory eyeballs, tumorous eyeballs, and differentiation between endocrine eyeballs.
