Etiopathogenesis of childhood proptosis

Abstract

Aim: To study the etiology, presentation and management of proptosis in children less than 14 years of age. Materials and Methods: This is prospective interventional study conducted at the department of Oculoplasty and Orbital diseases of Sarojini Devi eye hospital, Hyderabad. Period of study was from August 2012 to July 2014. 120 eyes of 111 children presenting as proptosis to the department were included in the study. Adult cases of Proptosis were excluded from the study. All cases underwent a detailed proptosis evaluation by an experienced oculoplasty surgeon. CT scan of orbit, axial and coronal view, 2mm cut without contrast was modality of imaging in all cases. CT scan with contrast was done in selected cases. Complete blood picture and surgical profile investigations were done. Cases were posted for excision or incision biopsy under general anaesthesia. Histopathological diagnosis was obtained in required cases. Culture and sensitivity of pus was done in infective cases. Results: 111(14.83%) cases of childhood proptosis were there out of 748 cases of proptosis presented during the study period to the department. The Male to Female ratio was 55:46. 102 cases were of unilateral proptosis and 9 were bilateral. Common etiology for childhood proptosis was 28 congenital, 18 infective, 20 parasitic, 36 neoplasm, 6 secondaries and 3 trauma cases. Of 111 cases 28 had acute proptosis, 25 had Sub acute presentation and 58 cases had chronic presentation. Management of 111 cases was done as follows: 48 cases underwent surgery, 41 were managed medically, 10 cases were referred to Medical Oncologist and 12 cases of congenital crouzons disease and microphthalmos were not intervened. Conclusion: Childhood proptosis forms 14.83% of total proptosis cases presenting at department of Oculoplasty and Orbital diseases. Etiological spectrum is different when compared to adult Proptosis.(1) Keywords: Congenital, Infective, Neoplasm, Parasitic, Proptosis