Cause Of Exophthalmos Research Articles

A Rare Case of Traumatic Cervicogenic Exophthalmos: A Case Report (P7-1.012)

<h3>Objective:</h3> NA <h3>Background:</h3> A cervical spine injury can cause headaches, vertigo, dizziness, tinnitus, and rarely unilateral exophthalmos. The relationship between cervical spine injury and reflex sympathetic dystrophy (RSD) is well established to explain the symptoms. Here, we present a patient developing bilateral exophthalmos after a fall with cervical spine injuries. Although unilateral cervicogenic exophthalmos has been suggested in the literature, we describe the first case of bilateral cervicogenic exophthalmos after a cervical spine injury. <h3>Design/Methods:</h3> NA <h3>Results:</h3> <h3>Case Report:</h3> A 53-year-old man presented after a fall at home. Trauma workup revealed hyperextension injury, anterior longitudinal ligament (ALL) disruption, and cord edema from C3-C6. After admission, the patient had quadriplegia and significant bilateral exophthalmos. He had urgent open reduction and internal fixation (ORIF) of C4-C5 and C5-C6, discectomies, and fusion with the insertion of plates and screws. After the surgery, his exophthalmos improved significantly. Unfortunately, multiple attempts to wean from the ventilator were unsuccessful. The patient’s family elected for compassionate extubation and discharge to hospice services per his living will, where he passed away. <h3>Conclusions:</h3> A cervical spine injury is a very rare cause of exophthalmos. Two case reports were found online for unilateral exophthalmos related to spondylosis of the cervical spine, which is thought to be caused by RSD, a chronic condition. Here we describe a patient presenting with significant bilateral exophthalmos secondary to the acute traumatic cervical spine. The patient’s bilateral exophthalmos improved significantly after his cervical spine surgery. To the best of our knowledge, ours is among the first few case reports of acute ‘traumatic cervicogenic exophthalmos.’ Further speculation is that the exophthalmos is probably associated with sympathetic nervous system hyperactivity related to cervical spine injury. <b>Disclosure:</b> Dr. Su has nothing to disclose. Dr. Zahra has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Varade has nothing to disclose.

Treatment of moderate to severe orbitopathy: Current modalities and perspectives

Graves’ orbitopathy (GO) is the primary cause of exophthalmos in adults. It appears in 30 to 50% of patients with Graves’ disease. About 5% are moderate-to-severe cases that might be see-threatening or lead to long term disabling sequelae. Recommendations have been established in 2016 by the European thyroid association (ETA) and the European group on Grave's orbitopathy (EUGOGO), suggesting a wide use of corticosteroids in moderate to severe forms. However, disappointing results have been reported in 20 to 30% of cases. Improved understanding of pathophysiological mechanisms has allowed the use of non-specific immunomodulatory agents, currently under evaluation, and which place in the therapeutic strategy remains to be determined. Very recently, new promising therapeutic advances have emerged with the identification of new therapeutic targets, such as the TSH receptor and IGF-1 receptor complex.

Potential of bony regrowth after deep lateral orbital decompression

The article describes a very rare case of bony regrowth after deep lateral orbital decompression for thyroid eye disease. Bony regrowth was observed in the area of the resected «trigone» of the greater wing of the sphenoid bone and in the area of the exposed dura mater. This case demonstrates that bony regrowth can be a possible cause of exophthalmos (proptosis) recurrence after orbital decompression in thyroid eye disease without clinical or laboratory evidence of reactivation of the disease.

Frequency of Thyrotoxicosis in Patient with One Sided Exophthalmos

Background: Thyroid associated Opthalmo-pathy is a condition of lid retraction causing a staring appearance. This occurs in any form of thyrotoxicosis as a result of sympathetic overactivity.Exophthalmos is the forward protrusion of eye ball beyond the orbital rim.&#x0D; Material &amp; Methods: This case series was observed in medical department Mufti Mehmood Teaching Hospital DIKhan, Pakistan over a period of eight months from February 2018 to September 2018. Detailed history with reference of duration of illness, mode of onset, progression and associated symptoms like fever, pain, diplopia and loss of vision was taken. Complete examination of orbit, eyelid, anterior and posterior segment was done. Routine Investigations along with special diagnostic tests like TFTs and MRI were performed to aid etiological diagnosis.&#x0D; Results: A total 47 patients were observed during this study period. Out of these 20 (21.27%) were male and 27 (57.44%) were female with male to female ratio 1:1.35 with mean age of 32 years. Out of 47 patients30 (63.82%) patients were having thyrotoxicosis as a cause of exophthalmos, 10(21.27%) were having retrobulbartumour, 5(10.63%) patients were with cavernous sinus thrombosis and 2(4.25%) patients were having idiopathic cause of exophthalmos.&#x0D; Conclusion: Thyrotoxicosis is the common cause of one sided exophthalmos and should be considered in all patients with one sided exophthalmos.

Equine retrobulbar disease: Diagnoses and outcomes of 15 horses with exophthalmos (1988–2017)

SummaryRetrobulbar disease, while rare in horses, can pose a clinical challenge due to the advanced diagnostic procedures necessary to determine the underlying aetiology and extent of disease. The goal of this study was to explore definitive causes of exophthalmos within a hospital population and investigate prognoses for the various aetiologies. Retrospective medical record review was used to identify 15 horses diagnosed with a definitive cause of exophthalmos. Patient signalment, disease duration, eye affected, diagnostic procedures, therapies, and histopathological diagnosis were evaluated. Geldings (12/15, or 80%) were over‐represented (P = 0.014). Mean age at presentation (14 ± 6.7 years) was not significantly different for horses with (14 ± 8.5 years) and without (15 ± 4.4 years) a diagnosis of neoplasia. Diagnosis of a neoplastic process was made in 8/15 horses (53.3%) with neuroendocrine tumour being most common. Eight of the 15 cases were classified as primary orbital disease, and seven represented extension from paranasal sinus disease. Two novel diagnoses were identified: cystic hamartoma arising from the lacrimal gland and orbital aspergillosis secondary to sinonasal disease. In total, eight of 12 horses for which follow‐up was available were euthanised due to orbital disease, two immediately following computed tomography of the skull and six due to disease progression. One horse was euthanised following a peri‐anaesthetic complication. Three horses were lost to follow‐up. Of the 12 horses for which follow‐up was available, only four (33.3%) were alive 21 months post‐diagnosis. Considering only patients for whom a definitive diagnosis was obtained, retrobulbar disease was associated with a poor prognosis for life.

A rare cause of exophthalmos in children

A rare cause of exophthalmos in children

Bilateral Harderian Gland Abscesses in a Syrian Dwarf Hamster (Mesocricetus auratus)

A 10-month-old Syrian dwarf hamster (Mesocricetus auratus) was evaluated for a presentation of acute unilateral exophthalmos of the right eye. Examination of the right eye revealed an exophthalmic eye, a dry cornea that appeared non-painful to touch, and eyelids dried and adhered to the ocular surface that did not close over the eye. Internal structures of the eye could not be visualized due to the diffuse desiccation of the cornea. The hamster was treated on initial presentation with temporary tarsorrhaphy, subcutaneous fluids, systemic antibiotics, and anti-inflammatory drugs. With environmental modification, the hamster did well at home for 8 days; however, the hamster died acutely after the contralateral eye ruptured and before further medical treatment. Necropsy revealed bilateral Harderian gland abscesses as the cause of exophthalmos, endophthalmitis, suppurative leptomeningitis, and encephalitis. Abscessation of the Harderian gland should be considered as a differential for hamsters presented with exophthalmos. The rapid progression of disease in this case suggests that aggressive, immediate therapy should be attempted in an effort to successfully treat this condition.

Recurrence of optic nerve neuropathy - a possible side effect of intravenous methylprednisolone pulses treatment

Graves' orbitopathy (GO) is the most common cause of exophthalmos. The most severe complication of GO is optic neuropathy. Endogenous hypercortisolism (Cushing syndrome) can also lead to exophthalmos by stimulating the proliferation of retrobulbar adipose tissue. Cases of the optic nerve neuropathy due to the glucocorticoids treatment have not been described, so far.

Orbital pseudotumor: a differential diagnosis of Graves' ophthalmopathy

The objective of this study is to report and discuss a rare and inflammatory cause of exophthalmos. This report describes a patient with exophthalmos, who was initially diagnosed with euthyroid Graves' with good response to therapy. After 8 years of follow-up, she had recurrence of symptoms and a new evaluation revealed the final diagnosis of orbital pseudotumor. Orbital pseudotumor is an uncommon disorder that both radiologically and clinically mimics a malignant process or other inflammatory disease, such as Graves' ophthalmopathy.

A retrobulbar abscess as an uncommon cause of exophthalmos in a horse

A retrobulbar abscess as an uncommon cause of exophthalmos in a horse

Unilateral exophthalmos caused by an invasive pituitary adenoma

A case of pituitary adenoma associated with unilateral exophthalmos is reported. An intraorbital infiltrative tumor growth was verified by histopathological study. The mechanism of exophthalmos is discussed, and edema of the intraorbital tissue secondary to an inflammatory reaction or venous stasis associated with tumor cell infiltration is considered to be the cause of exophthalmos in this patient. (Neurosurgery 21:716-718, 1987)

Diagnostic and therapeutic considerations in carotid-cavernous fistulas as a cause of exophthalmos

The clinical signs of 26 patients with a spontaneous carotid-cavernous fistula and of 21 patients with a traumatic one are described. It is demonstrated that Doppler velocity measurements are of great value for the diagnosis of this kind of communications. Conservative treatment in dural fistula and balloon embolization in direct fistula were successful in 16 of the 23, and 11 of the 12 cases, respectively.

Ultrasonography. VI. Pseudotumors of the orbit.

Orbital pseudotumors are an important cause of unilateral exophthalmos and a significant cause of bilateral exophthalmos. These chronic inflammatory processes may cause focal orbital lesions, diffuse inflammation of normal orbital tissues, or both. The present report is based on a series of 35 proven cases of pseudotumor of the orbit, and describes the B-scan ultrasonographic appearance of the orbit in this condition. The presence of an orbital pseudotumor as a cause of exophthalmos is suggested by certain clinical features, but these are not diagnostic. B-scan ultrasonography can often demonstrate the presence of an orbital mass lesion or inflammatory edema of normal orbital structures, or both, in suspected cases of orbital pseudotumor, and can aid the clinician in management of these difficult problems.

Myeloma: unusual cause of exophthalmos. An angioarchitectural study.

The solitary or multicentric myeloma is an uncommon cause of exophthalmos. The angioarchitectural features found in these cases include subtle, increased vascularity, a rather homogeneous tumor stain, possible minute tumor vessels, rapidity of circulation, and involvement of meningeal vessels. The stain may be intimately related to the abnormalities of bone. The recognition of this lesion requires further investigation to exclude systemic disease. The lesion resulting in exophthalmos may be treated by irradiation to obviate surgery.

MECHANISM OF THE PRODUCTION OF EXOPHTHALMOS IN EXOPHTHALMIC GOITER

The occurrence of exophthalmos in exophthalmic goiter has always been a most interesting and baffling pathologic problem to the medical profession, clinicians and experimenters alike. The importance of any condition as prevalent and as disfiguring as exophthalmos is apparent. It is hoped that a study of the mechanism of the production of ocular proptosis in the research laboratory may eventually lead to an understanding of the causation of both the exophthalmos and the other manifestations of exophthalmic goiter. At present there is no unanimity of opinion concerning the pathogenesis of the exophthalmos. Sufficient clinical and experimental evidence has been assembled to incriminate the sympathetic nervous system, the thyroid gland and the anterior lobe of the hypophysis. As the following review indicates, it is impossible to select a single local or general cause of exophthalmos at the present time. <h3>ROLE OF ORBITAL DISEASE</h3> Although the syndrome of exophthalmic goiter had been