Cause Of Proptosis Research Articles

ANAESTHESIA MANAGEMENT IN A CASE OF HYPERTHYROID WITH PROPTOSIS FOR ENDOSCOPIC DECOMPRESSION

This article describes a case of a 65-year-old man with hyperthyroid and who underwent left orbit endoscopic decompression for left eye proptosis. The article also discusses the management of thyroid eye disease (TED) in general. Thyroid associated orbitopathy, also known as Graves orbitopathy, is the most common cause of proptosis ( bulging of the eye). It is an autoimmune disease that affects the muscles and fatty tissues around the eye. TED is most commonly associated with Graves disease, an autoimmune disease that causes an overactive thyroid gland. However, TED can also occur in people with normal thyroid function or an hyperactive thyroid gland. The article presents a case of a 65-year-old man with TED who underwent decompressive surgery to relieve pressure . The article also discusses the importance of maintaining euthyroid (normal thyroid function) in patients with TED.

An approach to proptosis: A review

Abstract Proptosis is a vision-threatening condition, where abnormal protrusion of one or both eyeballs develop outwards from the orbit. Clinically, it is defined as a protrusion of the eyeball beyond 21 mm from the orbital rim or an asymmetry of more than 2 mm between both eyes. It can be classified based on onset as acute, sub-acute and chronic proptosis. The causes of proptosis can be broadly classified into infectious, inflammatory, autoimmune, endocrine, vascular, traumatic, and neoplastic entities. Quantitative measurement of proptosis is done by exophthalmometers such as Hertel’s, Luedde’s, Naugle and Gormaz exophthalmometers. Proptosis is evaluated using multiple investigations involving laboratory, ocular, radiological and histopathological studies. This article provides insight into various types, etiologies, and approaches toward the evaluation, diagnosis, and management of proptosis.

Repurposing picropodophyllin as a potential thyroid eye disease treatment via delaying mitotic clonal expansion through a patient‐derived preclinical platform

Repurposing picropodophyllin as a potential thyroid eye disease treatment via delaying mitotic clonal expansion through a patient‐derived preclinical platform

The Isabel Differential Diagnosis Generator for Orbital Diagnosis.

The Isabel differential diagnosis generator is one of the most widely known electronic diagnosis decision support tools. The authors prospectively evaluated the utility of Isabel for orbital disease differential diagnosis. The terms "proptosis," "lid retraction," "orbit inflammation," "orbit tumour," "orbit tumor, infiltrative" and "orbital tumor, well-circumscribed" were separately input into Isabel and the results were tabulated. Then the clinical details (patient age, gender, signs, symptoms, and imaging findings) of 25 orbital cases from a textbook of orbital surgery were entered into Isabel. The top 10 differential diagnoses generated by Isabel were compared with the correct diagnosis. Isabel identified hyperthyroidism and Graves ophthalmopathy as the leading causes of lid retraction, but many common causes of proptosis and orbital tumors were not correctly elucidated. Of the textbook cases, Isabel correctly identified 4/25 (16%) of orbital cases as one of its top 10 differential diagnoses, and the median rank of the correct diagnosis was 6/10. Thirty-two percent of the output diagnoses were unlikely to cause orbital disease. Isabel is currently of limited value in the mainstream orbital differential diagnosis. The incorporation of anatomic localizations and imaging findings may help increase the accuracy of orbital diagnosis.

Etiological Pattern, Clinical Presentation and Outcome of Patients with Proptosis in a Tertiary Care Hospital

Objective: To determine the etiological pattern, clinical presentation and outcome of patients with proptosis in a tertiary care hospital.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Ophthalmology Department, Khyber Teaching Hospital, Peshawar Pakistan, from Jan 2019 to Jun 2020.
 Methodology: This study was conducted on 60 patients having proptosis. Patients were treated either medically, surgically or both. The demographic profile included age, gender and type of proptosis. The outcome included recovery, re-treatment,referral to the relevant speciality and loss to follow-up, were measured.
 Results: Out of 60 patients with proptosis, 39 were males, and 21 were female. Fifty-two patients had unilateral, and 8 had bilateral proptosis, with the majority suffering from non-axial proptosis. On aetiology exhibited tumours (45%), infectious (25%), inflammatory (16.6%), vascular (6.66%) and injury (6.66%). The surgical procedure was indicated in 27(45%) patients,while medical treatment was given in 28(46.6%) patients. Five patients (8.4%) received both surgical and medical treatment. Out of 60 patients, 26 patients (46.33%) fully recovered and 11 patients (18.33%) did not recover, 17(28.33%) patients were referred to other specialities for management, and 5(8.3%) patients lost to follow-up.
 Conclusion: In our study, tumours were the main cause of proptosis, followed by infective and inflammatory causes, with the paediatric age group (<18 years) at more risk.

Letter to the Editor “Challenges of Meeting Cerebrovascular Surgery Demands in Low-and Middle-Income Countries: An Experience from Iraq”

The endoscopic endonasal approach (EEA) was originally performed to treat thyroid orbitopathy and proptosis. Since then, this approach also has been used to treat other causes of proptosis. This review systematically identifies surgical outcome and complication rates in patients without thyroid proptosis who underwent endoscopic endonasal orbital decompression.Databases were searched using the following search terms: orbital disease, surgical decompression, and endoscopic endonasal approach. Two independent reviewers screened all abstracts and titles for relevance and all articles passing this screen were subjected to full-text review. To assess risk of bias, we used ROBINS-I (Risk Of Bias in Non-randomized Studies–of Interventions).Eight studies with a total of 74 patients with nonthyroid proptosis were included. Pre- and postoperative eye examination was performed in all studies, but the extent of examination was varying. With a mean age of 35.7 years, most patients were adolescent, and most pathologies induced unilateral proptosis Complications to EEA for orbital decompression were transient diplopia (5 patients/6.8%), transient facial dysesthesia (2 patients/2.7%), ptosis (1 patient/1.4%), infarction (1 patient/1.4%), sinus obstruction (1 patient/1.4%), and enophtalmos (1 patient/1.4%). The authors reported successful reduction of proptosis in all but 2 patients (97.2%), and only 2 authors reported a need for secondary decompression.Medial orbital decompression using EEA is a feasible approach for orbital decompression in patients with nonthyroid proptosis. While being comparable in primary outcome to transorbital approaches, the EEA seems superior in terms of complication rates

Orbital MRI in thyroid-associated orbitopathy

Aim: Thyroid-associated orbitopathy (TAO) is the most common cause of proptosis in adults and the clinical picture is mostly associated with thyroid dysfunction. MRI is frequently used because of its advantages, such as high soft tissue resolution, multiple plane evaluation, and no risk of ionizing radiation exposure to the lens. The research aim was to present cases of thyroid orbitopathy with MRI findings and to compare the findings with existing literature.
 Material and Method: Patients who visited our radiology clinic with a preliminary diagnosis of TAO between April 2015 and February 2021 and underwent orbital MRIs were included in the study. We evaluated parameters such as age, sex, presence of proptosis, orbital muscle involvement, increase in orbital fatty tissue, and lacrimal gland involvement. 
 Results:A total of 35 patients were included in our study. The mean age was 40.6 (18-60) years, 19 (54%) patients were female, and 16 (46%) were male. All patients were diagnosed with Graves’ disease, whereas no patient was diagnosed with Hashimoto’s thyroiditis. The most common findings were proptosis in 33 (94%) patients, inferior rectus involvement in 27 (77%) patients, and medial rectus muscle involvement in 25 (71%) patients. No significant correlation was found between the presence of uni/bilateral involvement and TSH values (p = 0.008).
 Conclusion: In conclusion, since the presence of orbital involvement is crucial for treating thyroid diseases, all orbital structures involved should be reported by imaging. Orbital MRI is an effective imaging modality in the detection and differential diagnosis of TAO.

Unilateral proptosis in a child-need for prompt diagnosis

Proptosis in a child often presents as a diagnostic dilemma. Proptosis can be secondary to infection or childhood malignancies. It warrants urgent and relevant investigations to facilitate correct diagnosis and treatment. The common causes of proptosis include infection and malignant lesions. Any delay in intervention in either of the causes can lead to significant morbidity or can impair the vision of the child. An orbital neoplasm in the pediatric age group is an uncommon clinical finding which can initially manifest as proptosis. Here, we report a case of a 2-year-old girl, presenting with progressive swelling of the right eye. An incisional biopsy confirmed the diagnosis of embryonal rhabdomyosarcoma (RMS). RMS is an aggressive tumor; hence, early diagnosis and prompt treatment are highly essential to prevent significant morbidity and can save the vision of the child.

UNILATERAL PROPTOSIS - A DIAGNOSTIC DILEMMA

Objective: To study epidemiology, presentation and management of cases with unilateral proptosis presenting at a tertiary care hospital.
 Study Design: Case series.
 Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jan 2016 to Dec 2017.
 Methodology: Retrospective analysis of hospital record of patients with unilateral proptosis was carried out. Data was entered and analyzed in SPSS version 22. Chi square test was used for statistical analysis.
 Results: Thirty-three cases of unilateral proptosis with a mean age of 41.79 ± 3.87 years were included in the study. Pain was the most common association. Proptosis was mild in 42.4%, moderate in 48.5% and severe in 9.1% cases. In 61% cases, diagnosis was made on excisional or incisional biopsy and on the basis of radio imaging in 39% cases. Most common cause of proptosis found was pleomorphic adenoma (12%). Patients with axial and non-axial proptosis were 48.5% and 51.5% respectively. Fourteen cases (42.5%) were managed surgically and 2 cases (6%) were observed. Total of 22 cases (67%) improved after treatment, 8 cases (24%) went into remission, 2 (6%) deteriorated, and 1 (3%) died in the study period.
 Conclusion: Unilateral proptosis is a diagnostic challenge. Pertinent history taking and detail examination is the key, but associated signs or symptoms not always point towards correct diagnosis. Tissue biopsy provides a conclusive diagnosis especially where radio imaging is doubtful.

Sinonasal undifferentiated carcinoma – a rare cause of proptosis in elderly

Sinonasal undifferentiated carcinoma is a rare and extremely aggressive sinonasal tract malignancy. It is a rapidly enlarging tumour and a highly destructive lesion. We hereby report a 71-year-old Malay male with progressive left proptosis for one month, associated with reduced vision in the left eye, intermittent diplopia and anosmia. He was later diagnosed as having sinonasal undifferentiated carcinoma. The patient subsequently underwent a series of radiotherapy and showed improvement following treatment. This case was reported to highlight the importance identifying this entity and emphasise that sinonasal undifferentiated carcinoma should be considered in an elderly patient with proptosis associated with nasal symptoms.

Proptosis as a Primary Symptom of Brain Arteriovenous Malformation.

Proptosis is a common yet cardinal symptom that may indicate the development of a wide range of diseases. Causes of proptosis are usually classified into vascular, inflammatory, endocrine, and neoplastic. Herein, the authors describe a case where proptosis manifested as the primary and only symptom of a massive brain arteriovenous malformation. Deprived of any other conventional symptoms and signs of a brain arteriovenous malformation, such as headaches, nausea, vision loss, increased ocular pressure, and so on, brain imaging played a key role in confirming the diagnosis of this patient. This case proclaims how imperative it is for ophthalmologists to consider the potential of brain arteriovenous malformation as a cause of proptosis and actively engage in brain imaging for diagnosis.

Factors associated with severity of orbitopathy in patients with Graves' disease.

PURPOSE:Graves' orbitopathy (GO) is one of the most frequent orbital disorders and is the most common cause of proptosis in adults. GO is described as chronic inflammation of orbital and periorbital tissues. This study aimed to evaluate the risk factors for severe GO in patients with Graves' disease (GD).MATERIALS AND METHODS:This was a prospective cross-sectional study done on 52 newly diagnosed patients of GD with GO documented by thyroid 99mTechnetium-pertechnetate scan at our center between May 2016 and May 2019. All patients underwent a comprehensive ophthalmological examination and laboratory and hormonal analysis. Clinical Activity Score (CAS) and severity were estimated as per the European Group on Graves Orbitopathy. Thirty-four patients with mild GO were compared with 18 patients with moderate-to-severe GO (severe) for baseline risk parameters.RESULTS:Majority of the patients had mild orbitopathy (34 [65.4%]) followed by moderate to severe (18 [34.6%]). CAS was active in 13.5% of the study group. There was a statistically significant male preponderance in severe GO. Current smoking increased the risk of severe GO (P = 0.003). Duration of GD symptoms at presentation was statistically significantly longer in severe GO patients than mild GO (P = 0.004). Thyrotropin receptor antibody (TRAb) titer significantly increased in severe GO group (6.2 ± 2.4 IU/L) when compared to mild GO (3.2 ± 1.6 IU/L) (P < 0.001). TRAb positivity was similar between groups. Braley's sign, i.e., the differential intraocular pressure (IOP) of >6 mmHg, was statistically significantly higher in severe GO (P < 0.001). Male gender, current smoking, TRAb >2 upper limit of normal (ULN), and differential IOP >6 mmHg were found to be associated with severe GO.CONCLUSION:Approximately 35% of the patients with GO have severe disease, with a higher risk in men. This study identified male gender, current smoking, TRAb >2 ULN, and differential IOP >6 mmHg to be associated with severe GO.

Etiologies of Proptosis: A review.

Proptosis, the protrusion of the eyeball from the orbit, results from a wide variety of pathologies that can be vision- or life-threatening. Clinical history, associated physical exam findings, and imaging features are all crucial in establishing the underlying etiology. The differential diagnosis is broad, and includes infectious, inflammatory, vascular, and neoplastic entities that range from benign and indolent, to malignant and aggressive. While treatment varies significantly based on the disease process, all are aimed at preserving vision, salvaging the globe, preventing disfigurement, and reducing mortality. Both internists and general ophthalmologists should be familiar with the causes of proptosis in order to initiate the work-up for, and appropriately triage, affected patients.

Role of Multidetector Computerised Tomography in Evaluation of Proptosis

Introduction: Proptosis is defined as bulging of eye anteriorly out of the orbit. Our main objective was to analyze the pattern of computerised tomographic findings in evaluation of proptosis. Computerised tomography (CT) is noninvasive, easily accessible, affordable and reliable imaging which helps in early diagnosis and prompt treatment.&#x0D; Methods: A descriptive cross sectional study of total 58 patients presenting with proptosis referred to our department of radiology for computerised tomography evaluation during one year period were undertaken into study. The clinical information provided by ophthalmologist also helped our study to derive into conclusion. SPSS version 20 software was used for statistical data analysis.&#x0D; Results: Out of 58 patients, the most common cause of proptosis was neoplasm constituting of 25 cases (43.1%). Retinoblastoma was the commonest orbital tumor. Out of remaining cases, 15 (25.8%) were infective, 14 (24.1%) were inflammatory, two (3.44%) were traumatic and remaining two cases (3.44%) had no definitive cause for proptosis. Bilateral proptosis was commonly associated with thyroid ophthalmopathy. Among the subjects 32 were male, 26 were female. Male: Female ratio was 1:1.23. Age group was ranging from 1 month to 73 years.Mean age was 26.4 ± 22 years.&#x0D; Conclusions: Computerised tomography has an important role in distinguishing the different types of lesions based on their characteristics, location and extension prior to undertaking definitive surgical and medical treatment. Overall accuracy of CT in our study was 81%, sensitivity of 82.6%, specificity of 80.6%, positive predictive value of 76% and negative predictive value of 86.2%.

Retrospective analysis of clinical profile of pediatric proptosis in a tertiary care hospital of Eastern India

Background: Pediatric proptosis can often present with puzzling clinical features and needs a systematic approach to avoid diagnostic dilemma. Aims and Objectives: To study the clinical and etiological profile, management, and outcome of pediatric proptosis. Materials and Methods: This retrospective noncomparative study involved the analysis of record files of 41 cases of childhood proptosis, who presented in the eye outpatient department and oculoplastic clinic between January 2013 and December 2016. Results: There were a total of 41 children, age varied from 6 months to 15 years. The maximum number of cases 25 (61%) were in the age group of 0–5 years. Male:female ratio was 1.77:1. Unilateral cases were found to be 31 (76%) and bilateral cases be 10 (24%). Neoplastic lesions constituted 22 (54%) of which benign lesions were 3 (14%) and malignant were 19 (86%). Among malignant, primary were 11 (58%) and secondary were 8 (42%). Inflammatory/infective lesions were 8 (20%). Conservative/medical management was given to 11 cases (27%). Surgery with pre- or post-operative chemo- or radio-therapy was the treatment of choice. Conclusion: Neoplastic lesions were found to the most common cause of proptosis in this study. Apart from detail ocular and systemic examination, final etiological diagnosis is possible in certain cases only after investigations such as peripheral smear, bone marrow examination, histopathological examinations, ultrasonography B-scan, computed tomography scan, and magnetic resonance imaging. Timely diagnosis and management can save the vision and many a times lives.

Aetiology and demographics of unilateral proptosis in Benin City

Background: Proptosis is a common presentation with a broad differential diagnosis in an ophthalmic clinic. Although the aetiology of unilateral proptosis is diverse, the impact may be sight-threatening and/or life-threatening if left unaddressed. Objective: To determine the aetiology and demographic pattern of proptosis seen in adult patients at University of Benin Teaching Hospital (UBTH) with a view to providing baseline information for improved practice. Study Design: A retrospective chart review. Methods: This was a retrospective chart review of all patients with proptosis at the UBTH eye clinic from January 2008 to December 2014. Information obtained included age at presentation, sex, duration of symptoms before presentation, predisposing factors and ocular and systemic examination investigations. Results: A total of 50 patients who had proptosis were identified during the period under review with a mean age of 37.60 ± 14.25 years. The age range was 17–66 years. There were 27 (54.0%) males and 23 females (46.0%), with a female-to-male ratio of 1:1.2. The common causes of proptosis were infection (orbital cellulitis) 36.0%, neoplasm (28.0%), idiopathic (18.0%), inflammation (12%) and traumatic (6.0%). Conclusion: Orbital cellulitis is the single most common cause of proptosis in this study.

Primary sinonasal meningioma: An uncommon cause of proptosis in children

Extracranial primary sinonasal meningioma is of a very uncommon occurrence. It can give rise to myriad of nasal symptoms, but proptosis as a result of the same is relatively lesser known. The definitive diagnosis is made only on histological examination. The importance of complete surgical removal is indubitable. Our case report citing the rarity of this tumor involving primarily the sinonasal cavities, leaving the brain undisturbed adds to the already small number of cases reported globally.

Proptosis in a previously well five-year-old boy

Neuroblastoma metastasis. Ophthalmic findings may be the first presentation of a neuroblastoma which is the commonest paediatric tumour to metastasise to the orbit. The primary tumour is usually intraabdominal. Approximately 10–20% of children will have orbital metastases [1Ahmed S. Goel S. Khandwala M. et al.Neuroblastoma with orbital metastasis: ophthalmic presentation and role of the ophthalmologists.Eye. 2006; 20: 466-470Crossref PubMed Scopus (36) Google Scholar, 2Dubois S.G. Kalka Y. Lukens J.N. et al.Metastatic sites in stage IV and IVS neuroblastoma correlate with age, tumour biology, and survival.J Pediatr Hematol Oncol. 1999; 21: 181-189Crossref PubMed Scopus (308) Google Scholar] and up to 50% are bilateral [3Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar, 4Alfano J.E. Ophthalmological aspects of neuroblastomatosis: a study of 53 verified cases.Trans Am Acad Ophthalmol Otolaryngol. 1968; 72: 830-848PubMed Google Scholar, 5Altonbary Y. Mansour A.K. Sarhan M. et al.Proptosis is a pediatric dilemma.Ann Pediatr Child Health. 2015; 3: 1066Google Scholar]. Proptosis and ecchymosis (“raccoon eyes”) are the commonest ocular manifestations [[3]Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar]. The most common cause of proptosis in a child is orbital cellulitis [[5]Altonbary Y. Mansour A.K. Sarhan M. et al.Proptosis is a pediatric dilemma.Ann Pediatr Child Health. 2015; 3: 1066Google Scholar]. Histiocytosis, haemangioma or lymphangioma are further benign causes. Malignant aetiologies include rhabdomyosarcoma, Ewing’s sarcoma, lymphoma and metastases from a neuroblastoma, bone tumours or leukaemia [[5]Altonbary Y. Mansour A.K. Sarhan M. et al.Proptosis is a pediatric dilemma.Ann Pediatr Child Health. 2015; 3: 1066Google Scholar]. Typical CT or MRI features are an extra-conal soft tissue mass arising from the wall of the orbit [[8]Lonergan G.J. Schwab C.M. Suarex E.S. et al.Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: Radiologic-Pathologic Correlation.Radiographics. 2002; 22: 911-934Crossref PubMed Scopus (478) Google Scholar]. As in this patient, it can be locally aggressive extending into the infratemporal fossa structures or intra-cranially, with bony destruction of the roof and wall of the orbit and resultant bony spiculation [3Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar, 6Wells R.G. Sty J.R. Gonnering R.S. Imaging of the pediatric eye and orbit.Radiographics. 1989; 9: 1023-1044Crossref PubMed Scopus (14) Google Scholar, 7Lallemand D.P. Brasch R.C. Char D.H. et al.Orbital tumours in children: characterisation by computed tomography.Radiology. 1984; 151: 85-88Crossref PubMed Scopus (8) Google Scholar]. The mass may be unilateral or bilateral, unlike a rhabdomyosarcoma which is typically unilateral [[3]Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar]. Furthermore, rhabdomyosarcoma may involve anterior pre-septal orbital structures but a neuroblastoma will usually not [[3]Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar]. Neuroblastomas can cause dural and leptomeningeal metastases, with involvement of the skull causing diastasis of affected sutures [3Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar, 8Lonergan G.J. Schwab C.M. Suarex E.S. et al.Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: Radiologic-Pathologic Correlation.Radiographics. 2002; 22: 911-934Crossref PubMed Scopus (478) Google Scholar]. This child had clinical, radiological and pathological findings consistent with metastatic neuroblastoma and an MRI abdomen (Fig. 2) revealed a left adrenal primary site. Proptosis in a previously well five-year-old boyJournal of Clinical NeuroscienceVol. 34PreviewA five-year-old boy presented with a one-week history of left-sided proptosis and retro orbital pain, with no prior medical or surgical history. On examination, there was left-sided proptosis with no visual field defect or other neurological abnormality. Full blood count, electrolytes and inflammatory markers were unremarkable. Full-Text PDF

A Rare Cause of Proptosis in Childhood: Langerhans Cell Histiocytosis.

A three-year-old male patient was admitted to the clinic with proptosis in his right eye. He had a history of fever with an unknown etiology. In examination, right proptosis was observed and an immobile mass was palpated at the lateral wall of the right orbita. Eye movement was unrestricted in all directions and anterior and posterior segment examination was normal in both eyes. On computed tomography, diffuse bone destruction and expansion was observed in the right orbital lateral wall and other cranial bones. Langerhans cell histiocytosis was diagnosed by bone biopsy. Malignancy is an important cause of proptosis in childhood. Pediatric patients who are admitted to clinic with proptosis should be carefully examined and Langerhans cell histiocytosis should also be considered as an etiology.

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

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.