Etiological pattern, clinical presentation, and management challenges of proptosis in a tertiary hospital in South West Nigeria

Abstract

Background: The etiology of proptosis is diverse ranging from orbital problem to infiltrative disease and spread from contiguous sites including nasopharynx, paranasal sinuses, and sometimes distant structures. It can also be part of systemic illness affecting multiple tissues and organs. Aim: This study aims to determine the demographic pattern and etiology of proptosis in a tertiary health facility in South Western Nigeria and to discuss the management challenges. Methods: This is a clinic-based retrospective descriptive analysis of all patients that presented with proptosis at the Eye Clinic of Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun state, Nigeria, over a 13-year period from 2000 to 2012. The hospital records of patients was used which was analyzed using Statistical package for Social sciences version 15. Results: A total of 175 cases of proptosis out of 15,266 new cases gave a hospital prevalence of 1.2%. The average age of the 138 patients analyzed was 37.8 years with a male to female ratio of 1:1. Children constituted 27.5%. Eighty-one (58.7%) patients presented within 1 month of onset of proptosis. Twenty-three (16.7%) had bilateral proptosis. Half of the studied population was secondary to orbital inflammation. The common causes of proptosis were infective 38.4%, mass/tumor 18.8%, noninfective inflammation 13%, and sinonasal diseases 10.9%. Eight (5.8%) were mucocele of paranasal sinuses. Thyroid-related eye disease and proptosis of vascular etiology were common in females. Computerized tomographic scan of the orbit and/or sinus/cranium was done in 11.4% of the patients. Thirty-seven (26.8%) patients defaulted. Conclusion: Infective process is the most common cause of proptosis from orbital cellulitis. Majority were unilateral with no sex predilection. Proptosis due to thyroid eye disease and vascular abnormality were found mostly in females. The management challenges were poor record keeping and inadequate personnel. Despite the threat to life and vision posed by some etiology of proptosis, a large number of the patients were unable to fund investigation and treatment while others defaulted from the facility.