Exophthalmometric Value Research Articles

Early response to intravenous methylprednisolone therapy for restrictive myopathy in patients with thyroid eye disease.

To report the therapeutic efficacy of intravenous methylprednisolone (IVMP) in patients with restrictive myopathy caused by thyroid eye disease (TED). The present prospective uncontrolled study comprised 28 patients with TED and restrictive myopathy who presented with diplopia that had developed within 6months before their visit. All patients were treated with IVMP for 12weeks. Deviation angle, limitation of extraocular muscle (EOM) movement, binocular single vision score, Hess score, clinical activity score (CAS), modified NOSPECS score, exophthalmometric value, and the size of EOMs on computed tomography were evaluated. The patients were divided into two groups: those whose deviation angle had decreased or remained unchanged 6months after treatment (group 1; n = 17) and those whose deviation angle had increased in that time (group 2; n = 11). The mean CAS of the whole cohort significantly decreased from baseline to 1month and 3months after treatment (P = 0.03 and P = 0.02, respectively). The mean deviation angle significantly increased from baseline to 1, 3, and 6months (P = 0.01, P < 0.01, and P < 0.01, respectively). The deviation angle decreased in 10 (36%), remained constant in seven (25%), and increased in 11 (39%) of the 28 patients. When groups 1 and 2 were compared, no single variable was identified as a cause of deviation angle deterioration (P > 0.05). When treating patients with TED who have restrictive myopathy, physicians should be aware that some patients show worsening of the strabismus angle despite inflammation control with IVMP therapy. Uncontrolled fibrosis can result in motility deterioration.

Changes in Dry Eye Status after Steroid Pulse and Orbital Radiation Therapies in Active Thyroid Eye Disease.

This prospective, observational study examined changes in dry eye status after steroid pulse and orbital radiation therapies in 16 patients (32 eyes) with active thyroid eye disease (TED). TED status was evaluated through clinical activity score (CAS), margin reflex distance (MRD)-1 and 2, presence or absence of Graefe’s sign/lid lag, and Hertel exophthalmometric value. Dry eye status was quantified through presence or absence of superior limbic keratoconjunctivitis, corneal fluorescein staining (AD score), tear break-up time, Schirmer test I results, tear meniscus height, and dry eye-related quality of life score. Meibomian gland dysfunction (MGD) was evaluated through Marx line score, eyelid abnormalities (MGD score), meibum expression score, and meibomian gland loss score. Those items were measured before and 6 months after treatment, and the results were statistically compared. Consequently, CAS significantly improved, and MRD-1 significantly decreased after treatment (p < 0.050). Although a part of MGD status improved (p < 0.050), all items regarding dry eye status did not change significantly after treatment (p > 0.050). Steroid pulse and orbital radiation therapies did not largely alter most items regarding dry eye and MGD status.

Orbital and periorbital anthropometric variations and effect of age and gender on these variables

Background: The objective of this study was to identify the orbital and periorbital anthropometric variations and determine the effects of age and gender on these variables. From January 2020 to July 2020, we conducted a hospital-based, descriptive, observational study. Material and methods: Three hundred and eighty individuals of age15 years and above were included in the study. Exophthalmometric value (EV) and outer inter-canthal distance (OICD) were measured [mm] on Hertel’s exophthalmometer. Inner inter-canthal distance (ICD), inter-pupillary distance (IPD) [mm], palpebral fissure width (PFW), palpebral fissure height (PFH), marginal reflex distance 1 (MRD1), marginal reflex distance 2 (MRD2), lid crease height (LC), pre-tarsal show (PTS) and levator function (LF) were recorded using a millimeter ruler scale. Data were analyzed using a Microsoft Excel sheet. Results: Out of 380 subjects, there were 222 females and 158 males. Mean EV was 15.86 mm, OICD — 105.57 mm, ICD — 31.7 mm, IPD — 59.55 mm, PFW — 29.7 mm, PFH — 10.04 mm, MRD1 — 4.21 mm, MRD2 — 5.87 mm, LC — 8.31 mm, PTS — 4.24 mm and LF —14.66 mm. Significant sexual dimorphism was noted in five parameters; EV, ICD, IPD, PFH and MRD2 were significantly higher in males versus females. PFH was decreased while PTS was increased in individuals of more than 40 years. Conclusion: There is a significant difference between males and females in some variables, and no difference was detected in others. Age did not significantly affect a majority of the variables.

Changes in Eyelid Pressure and Dry Eye Status after Orbital Decompression in Thyroid Eye Disease.

The aim of this prospective observational study was to examine changes in eyelid pressure and dry eye status after orbital decompression in thyroid eye disease (TED). In 16 patients (29 sides), upper eyelid pressure at plateau phase and maximum pressure were measured. TED status was evaluated through the Hertel exophthalmometric value and margin reflex distance (MRD)-1 and 2. Dry eye status was quantified through corneal fluorescein staining, tear break-up time, Schirmer test I results, meibomian gland dysfunction (MGD), tear meniscus height, and superior limbic keratoconjunctivitis (SLK). Patients were classified into two groups: patients with decreased eyelid pressure (Group 1) and those with elevated pressure (Group 2). Consequently, neither the maximum upper eyelid pressure nor pressure at plateau phase significantly changed after surgery (p > 0.050). Some parameters about MGD improved after surgery, but the other parameters on dry eye, MGD, and SLK worsened or did not change. MRD-1 decreased more (p = 0.028), and the ratio of patients in whom SLK improved after surgery was larger in Group 1 (p = 0.030). These results indicate that upper eyelid pressure tends to decrease postoperatively in patients with a high upper eyelid position, resulting in improvement of SLK.

Choroidal vascularity index in thyroid-associated ophthalmopathy: a cross-sectional study

BackgroundHemodynamic changes have been observed in patients with Graves’ disease. The aim of our study was to evaluate choroidal vascular change using the choroidal vascularity index (CVI) in patients with thyroid-associated ophthalmopathy (TAO).MethodsIn this cross-sectional observational study, 40 patients affected by TAO were recruited. Forty healthy individuals, matched for age and sex, served as controls. Foveal enhanced-depth imaging optical coherence tomography scans were obtained from all participants. Images were binarized using the ImageJ software and luminal area (LA) and total choroidal area (TCA) were measured. CVI was calculated as the proportion of LA to TCA. The relation between CVI or subfoveal choroidal thickness (SFCT) and clinical activity score, exophthalmometric value, diplopia status, gender, and age was evaluated.ResultsCVI was significantly higher in patients with TAO (P = 0.004). No significant difference was observed in SFCT (P = 0.200) and TCA (P = 0.153) comparing TAO patients and healthy controls. LA was significantly higher in TAO group (P = 0.045). On multiple regression analysis, CVI was associated with TCA (P = 0.043). No association was found between SFCT or CVI and TCA, clinical activity score, exophthalmometric value, Inami value, diplopia status, gender or age (P > 0.05).ConclusionsThis is the first study that has demonstrated an increase in CVI in eyes with TAO compared with healthy controls and has assessed its association with clinical features.

The study of relationship between ocular biometry and exophthalmometry in adult Malay population of Kelantan, Malaysia.

PURPOSE:Exophthalmometry value has great clinical significance in the presence of many orbital diseases which can cause proptosis, including thyroid-associated orbitopathy, tumors, inflammation, head and orbital trauma, and craniofacial abnormalities. Measurements of exophthalmometry and ocular biometry vary between races and countries. This study aimed to present the normative values of exophthalmometry in adult Malays of Kelantan and the relationship between ocular biometry (axial length, corneal curvature, anterior chamber depth, and white-to-white) with the obtained exophthalmometry values.MATERIALS AND METHODS:This was a hospital-based, cross-sectional study in the Ophthalmology Clinic of Universiti Sains Malaysia, Kubang Kerian, Kelantan, where 267 individuals above 20 years old participated between August 2018 and May 2020. Participants were examined with Hertel exophthalmometer and intraocular lens Master by the same investigator. Data were analyzed using the Statistical Package of the Social Science software (version 24.0). Multiple linear regression was used to assess any significant correlation between exophthalmometric value and each biometric variable.RESULTS:In the data collected, the mean exophthalmometric value for the right eye was 13.93 ± 2.221 mm and the left eye was 13.93 ± 2.232 mm. Overall, male had a higher exophthalmometric value than the female with a statistically significant P = 0.001. Axial length was uniquely significant for the amount of variance in the exophthalmometric value with P < 0.001, while corneal curvature, anterior chamber depth, and white-to-white showed no statistical significance.CONCLUSION:Our study had established the normal exophthalmometric value for Malay adults in Kelantan for future clinical reference. The axial length had shown to have a significant positive correlation with exophthalmometric values.

Retinal, choroidal and optic disc analysis in patients with Graves' disease with or without orbitopathy.

To compare optic disc, retinal and choroidal measurements in patients with Graves' disease with or without orbitopathy, and healthy controls. Optical coherence tomography and Heidelberg retinal tomography were performed in 40 patients with Graves' orbitopathy (GO), 40 subjects with Graves's disease (GD) with no sign of orbitopathy and 40 healthy controls. Degree of exophthalmos, ocular alignment, clinical activity score (CAS), choroidal thickness, retinal thickness, ganglion cell layer (GCL) thickness, disc area, cup area, rim area, cup/disc area ratio, linear cup/disc ratio and mean peripapillary retinal nerve fibre layer thickness were analysed. GO patients and healthy controls significantly differ regarding mean central retinal thickness (275 ± 19µm and 285 ± 20µm, P = 0.017); mean central GCL thickness (14.87 ± 3.0µm and 17.92 ± 5.02µm, P = 0.001); mean disc area (2.00 ± 0.44mm2 and 1.72 ± 0.37mm2, P = 0.003); mean cup area (0.53 ± 0.52mm2 and 0.31 ± 0.20mm2, P = 0.003); cup/disc area ratio (0.22 ± 0.10 and 0.17 ± 0.08, P = 0.010); and linear cup/disc ratio (0.47 ± 0.15 and 0.40 ± 0.13, respectively, P = 0.011). No difference was found between patients without orbitopathy and healthy controls. No significant difference was found regarding the choroidal thickness between the three groups. There was no statistically significant relationship between retinal thickness, ganglion cell layer thickness, mean disc area, mean cup area, cup/disc area ratio, linear cup/disc ratio, CAS, exophthalmometric value and ocular alignment. GO patients showed significant changes in foveal and GCL thickness, and optic nerve head morphology suggesting a possible influence of the orbital inflammatory process.

Association of anthropometric markers with globe position: A population-based MRI study.

PurposeExophthalmometry is a common examination in ophthalmology. For example it is relevant for diagnosis or follow-up of thyroid eye disease. However, exophthalmometry is affected by several factors such as ethnicity, sex and age. The purpose of this study was to determine the globe position by magnetic resonance imaging (MRI) and to investigate its correlates among the general Northeast German adult population.MethodsA total of 3030 subjects aged between 20 and 89 from the population-based Study of Health in Pomerania (SHIP) underwent a standardised whole-body MRI. Axial length and globe position were determined in axial T1-weighted images of the orbit. The image had to include the corneal apex as well as the optic nerve head. Study participants were excluded from imaging analysis if there was no plane available that included both structures. Further exclusion criterion was a lateral deviation of the subject’s viewing direction. Images with inadequate quality due to motion artefacts or other technical reasons were excluded as well. Globe position was defined as the perpendicular distance between the interzygomatic line and the posterior surface of the cornea (exophthalmometric value). The distance between the posterior surface of the cornea and the posterior pole of the eyeball, at the boundary with orbital fat, was defined as axial length. We used posterior surface of the cornea for our measurements, because it seemed to be less vulnerable for motion artefacts than the anterior one. Moreover body measurements including body mass index (BMI), waist and hip circumferences were determined. Associations between anthropometric measurements with exophthalmometric outcomes were analysed by linear regressions adjusted for age and stratified by sex. P-values <0.05 were considered as statistically significant. To assess intra-reader variability intra-class correlation coefficients (ICC) were computed for repeated measurements of the MRI scans of 25 subjects.ResultsAfter considering the exclusion criteria 1926 evaluable subjects remained. There was no significant difference between means of right and left eyes. The mean exophthalmometric value was significantly higher in men (16.5 +/- 2.2 mm) than in women (15.3 +/- 2.1 mm). The mean MRI-axial length was 23.4 +/- 0.8 mm for men and 22.8 +/- 0.9 mm for women. BMI, waist and hip circumferences were positively correlated with exophthalmometric value (p<0.001). Difference of mean MRI-based exophthalmometric value for obese subjects (BMI ≥30 kg/m2) and non-overweight (BMI <25 kg/m2) was 2.1 mm for men and 1.6 mm for women. ICC between 0.97 and 0.99 indicate excellent repeatability of our method.ConclusionWe conclude that MRI-based exophthalmometric values are positively correlated with BMI, waist- and hip-circumference among the general Northeast German adult population. This association is independent from age and axial length. Consequently bodyweight of patients should be regarded to interpret exophthalmometric values correctly. MRI-exophthalmometry seems to be a suitable method to determine globe position. Considering the large number of study participants, exophthalmometric values of our study could be used as comparative values for exophthalmometry of people of Western European descent in future.

Measurement of Intra-Orbital Structures in Normal Chinese Adults Based on a Three-Dimensional Coordinate System

ABSTRACT Purpose of the study This study was to establish a three-dimensional (3D) coordinate system and to study the normal dimensions of intra-orbital structures in Chinese adults. Materials and methods One hundred and forty-five adult Chinese were selected from patients who had undergone cranio-facial computed tomography scans with diagnosis other than orbital or ocular abnormality. An orbital 3D coordinate system was built on the basis of the scans. Morphological variables of intra-orbital structures were measured in this coordinate system. Bilateral symmetry, sexual dimorphism, and correlations between variables were investigated. Results No evident laterality was found in bilateral intra-orbital structures. The distance from the center of the eyeball to the prechiasmatic groove, the length of the optic nerve, and the thickness of rectus extraocular muscles were larger in males than in females. No sex-related difference was observed in the anteroposterior diameter of the eyeball or the exophthalmometric value. The exophthalmometric value was found to be related to the anteroposterior diameter of the eyeball, whereas the y-coordinate of the center of the eyeball had no correlation with the anteroposterior diameter of the eyeball. The optic nerve length was closely correlated to the distance from the center of the eyeball to the prechiasmatic groove. Conclusions The 3D coordinate system and measurement method established in this study can be applied to the standardization of orbital morphometry. The measurements obtained from normal Chinese adults may provide reference values for the morphology of intra-orbital structures.

Correlation between Hertel exophthalmometric value and refraction in young Cameroonian adults aged 20 to 40 years.

PurposeTo study the relationship between exophthalmometric value (EV) and refractive error in Cameroonian young adults.Patients and methodsA prospective descriptive study was carried out in the ophthalmic unit of the Yaoundé Central Hospital from March to May 2015. Consenting patients aged 20–40 years with no intraocular pathology who were seen for refractive errors were included. Ocular protrusion was measured using the Hertel exophthalmometer. Automatic refraction was done following cycloplegia with cyclopentolate and tropicamide.ResultsA total of 200 patients were included (68% females and 32% males). The mean age was 27.2±6 years. Hyperopia was the most common refractive error (51%), followed by hyperopic astigmatism (19.3%). EV varied between 9 mm and 23 mm, with a mean of 14.8±2.5 mm in the right eye and 15.0±2.5 mm in the left eye. The mean EVs were 17.10±2.80 mm in myopia, 14.24±1.92 mm in hyperopia, 16.72±2.58 mm in myopic astigmatism, 14.07±2.19 mm in hyperopic astigmatism, and 14.77±2.40 mm in mixed astigmatism. The spherical value had a negative correlation with EV (P=0.0000).ConclusionThe mean EV of this Cameroonian population is smaller than that of other populations and is consistent with the known characteristic hyperopic status of the population. A study on a larger sample will determine the normative data of absolute and relative EV in our setting.

Biometric and refractive changes after orbital decompression in Korean patients with thyroid-associated orbitopathy.

To determine the biometric and refractive changes after orbital decompression in Korean patients with thyroid-associated orbitopathy (TAO). Retrospective, observational study (between October 2012 and September 2014) was performed. Patients with TAO undergoing orbital decompression for stable proptosis received ophthalmic examinations, including Hertel exophthalmometry, A-scan biometry, autorefraction measures, corneal topography, and wavefront aberration measures, before orbital decompression and again 2 months after surgery. Included in the study were 43 eyes from 23 patients. The mean exophthalmometric value decreased by 4.1 mm 2 months after orbital decompression (P<0.001). On average, axial length (AL) increased significantly by 0.08 mm (P<0.001); specifically, 37 (86%) of the 43 eyes had increased AL. Whereas anterior chamber depth and lens thickness showed no significant changes (P=0.086 and P=0.905, respectively), the mean spherical refraction and spherical equivalent (SE) decreased by 0.35 and 0.48 D, respectively (P=0.008 and P<0.001, respectively). However, cylindrical refraction and axis showed no significant changes (P=0.057 and P=0.218, respectively). The changes in AL and SE were significantly correlated (R=-0.411, P=0.009). Notably, there were no changes in corneal topography or wavefront aberration after orbital decompression. TAO patients who underwent orbital decompression showed myopic refractive change via increase in AL. Possible refractive changes should be considered in cases of TAO complaining of decreased visual acuity after orbital decompression.

Usefulness of the ratio of orbital fat to total orbit area in mild-to-moderate thyroid-associated ophthalmopathy.

To identify a useful predictor of thyroid-associated ophthalmopathy (TAO) from orbital CT images; to evaluate the orbital fat and extraocular muscle area ratio as a CT-derived measure; and to investigate the correlations between this ratio and the clinical manifestations in mild-to-moderate TAO. Between January 2012 and March 2013, 44 patients with TAO and 23 controls were studied prospectively. All of the patients underwent ophthalmic examinations, including clinical activity score, exophthalmometry, clinical photographs, alternate prism and cover test, duction and version test, Hess screen test, binocular single vision test, thyroid function tests and orbital CT. The cross-sectional areas of the four rectus muscles, superior oblique muscle, optic nerve and total orbit area were calculated in the coronal view 6 mm posterior from the posterior pole of globe. The cross-sectional area measured on orbital CT showed increased orbital fat in patients with TAO and an increased orbital fat to total orbit area ratio (fat/orbit) in TAO with retraction and proptosis. There were significant correlations between fat/orbit and margin reflex distance 1 (p = 0.022), margin reflex distance 2 (p = 0.013) and the exophthalmometric value (p = 0.007). The orbital fat to total orbit area ratio (fat/orbit) is a useful diagnostic index in mild-to-moderate TAO. The orbital CT offers a useful diagnostic index in TAO.

Orbital Volume Augmentation After Injection of Human Orbital Adipose-Derived Stem Cells in Rabbits

This randomized, controlled animal study investigated the morphologic and histologic properties of rabbit orbital fat following injection of human orbital adipose-derived stem cells (hoADSCs). The efficacy of hoADSCs was compared to that of hyaluronic acid gel (HAG) and human orbital stromal vascular fraction (hoSVF). A total of 30 orbits from 15 New Zealand white rabbits (25 weeks postnatal, 2500-3000 g) underwent injection with HAG (molecular weight [MW] 1,000,000, 0.5 mL, n = 10, HAG only), hoSVF (0.25 mL) mixed with HAG (0.25 mL, n = 10, HAG + hoSVF), or hoADSCs (0.25 mL) mixed with HAG (0.25 mL, n = 10, HAG + hoADSCs). The degree of proptosis, and the time course of changes were determined and compared among groups. The difference between the initial exophthalmometric value and that at 4 weeks after injection was 1.77 mm for HAG only and 2.01 mm for HAG + hoSVF. The difference between the initial value and that at 12 weeks decreased to 0.05 mm for HAG only and 0.24 mm for HAG + hoSVF. In contrast, injection of HAG + hoADSCs increased the exophthalmometric value by 2.43 mm at 4 weeks after injection, and this difference was maintained at 2.56 mm at 12 weeks. Histopathologic examination revealed specific inflammation around the injection materials at 4 weeks after injection, and inflammation subsided 8 weeks after injection in all three groups. Thus, transplantation of hoADSCs with HAG is a safe and effective technique for orbital fat volume expansion. This is a new and promising method for orbital reconstruction and aesthetic orbital volume augmentation.

The effect of previous orbital decompression on results of strabismus surgery in patients with Graves' ophthalmopathy

To evaluate the effect of previous orbital decompression on the success of strabismus surgery in patients with Graves' ophthalmopathy. The medical records of patients who underwent strabismus surgery for Graves' ophthalmopathy were retrospectively reviewed. Patients were divided into two groups according to whether they had previously undergone orbital decompression. Success was defined as no diplopia in primary and downgaze or no diplopia with prisms no more than 8(Δ) horizontally and 4(Δ) vertically. The effect of strabismus surgery on the amount of proptosis was also evaluated. A total of 56 patients with Graves' ophthalmopathy were included. Of these, 27 had undergone orbital decompression before strabismus surgery and 29 patients had not. The two groups did not differ in terms of the average angle of preoperative horizontal or vertical deviations and the average numbers of muscle that underwent surgery. The postoperative exophthalmometric value decreased an average of 0.4 mm in the decompression group and 0.2 mm in the nondecompression group. The success rate of the surgery was 92.6% in patients who had previous decompression and 93.1% in patients who had not. Previous orbital decompression surgery had no significant effect on the outcomes of strabismus surgery or on postoperative change in proptosis in patients with Graves' ophthalmopathy.

The relationship between exophthalmometric values, palpebral dimensions, and height, body weight/mass index: The Ido eye study

Background: Age and sex are some of the documented factors that have impact on the exophthalmometric/palpebral values. However, little is known in our population on this relationship. Therefore, this study was conducted to find out the effect of age and sex on exophthalmometric and palpebral values in our local population. Aims: To investigate the relationship between exophthalmometric values, palpebral fissure dimensions, and height, body weight/body mass index (BMI) in an African population. Settings and Design: A descriptive cross -sectional survey wherein participants were recruited using multi -stage random sampling technique in a population -based setting. Materials and Methods: Exophthalmometric values (EVs) and palpebral fissure dimensions (PD) were measured in 1020 eligible adults with their consent, using Hertel's exophthalmometer and non -stretchable plain plastic ruler, respectively. Weight and height of the subjects were measured using stadiometer and weighing scale, respectively, and the BMI was calculated. Summary statistical analysis was performed for EV and PD, and their relationship with height and body weight/BMI was tested with Pearson's correlation analysis. Variables significant on bivariate analysis were entered into a multiple linear regression model. Statistical Analysis: Data were analyzed using SPSS version 17. Correlation between exophthalmometric measurements, PD, and height, body weight/BMI was tested using Pearson's correlation analysis. Variables significant on bivariate analysis were entered into a multiple linear regression model where regression coefficients and their 95% confidence intervals were computed. Level of significance for all tests was at 5%. Results: The studied population comprised 1020 subjects including 515 females and 505 males. Exophthalmometric value had statistically significant positive associations with body weight/BMI ( r = 0.113, P r = 0.094, P = 0.003, respectively). For every 1 kg increase in weight, there was accompanying 0.639 mm (95% CI = 0.330 -0.945) increase in EV, while there was 0.05 mm increase in EV for every 1 kg/m 2 increase in BMI. Conclusion: Weight is an independent predictor of exophthalmometric value, palpebral fissure width, medial canthal distance, and lateral inter -canthal distance.

Age dependant somatometric and cephalometric variables among Nigerians.

Background: The process of growth passes through stages of developmental processes. This stage is the age. Age is known to affect many parameters in the body and this includes somatometric and cephalometric variables. Methods: The study was conducted with a total number of 409 students of university of Jos, St Murumba and School of Higher Islamic Secondary School Jos. The following cephalometric and somatometric parameters were measured viz; Age, Weight, Height, Head width, Bizygomatic distance, Upper facial height, Outer canthal distance, Palpebral fissure length,Exaphthalmometric value, Ear width, Nose width were measured. Result: This study showed a positive relationship between age and weight, height, outer canthal distance, papebral fissure length, exophthalmometric value, nose width, bizygomatic distance (p 0.01) and head width (p 0.05). But it showed a negative significant relationship with ear width and upper facial length (p 0.01). Conclusion: It is concluded that the interrelation of age and the above studied somatometric and cephalometric parameters may give an understanding of craniofacial development and congenital anomalies. Key words: Age, Somatometric, Cephalometric.

Exophthalmos of patients with Graves' disease in Chinese of Taiwan

To determine the exophthalmos measurements in patients with Graves' disease (GD) and to compare with those of normal subjects among the Chinese of Taiwan. Hertel's exophthalmometry were performed in 163 consecutive adult GD patients and 419 normal subjects. The values of exophthalmos, asymmetry, and the distance between lateral orbital rims (base) were evaluated. There was a significant difference between GD and normal adults for exophthalmos and asymmetry, with GD patients demonstrating a mean exophthalmos of 18.32 mm and asymmetry of 0.93 mm as compared with 13.91 and 0.55 mm for normal subjects (P<0.001). The mean value of base for GD adults (106.52 mm) is slightly greater than normal subjects (105.82 mm). There was no gender difference in exophthalmometric value or asymmetry in each group. A total of 79 (48.5%) GD patients had exophthalmos greater than the upper limit of normal Chinese in Taiwan (18.6 mm). Asymmetry over 2 mm was observed in 11 (6.7%) patients with GD but in none of the normal subjects. GD patients have significant exophthalmos and asymmetry compared to normal subjects. In comparison with previous studies, exophthalmos values for Chinese in Taiwan tend to be lower than those of Caucasians and black-American people, but are close to those of Korean, Japanese, Iranian, Indian, and Asian-American people. Adequate adjustment of normal and abnormal values of exophthalmos according to individual differences is important for the diagnosis of orbital morbidity and management of thyroid associated orbitopathy.

Correction of Superior Sulcus Deformity and Enophthalmos with Porous High-density Polyethylene Sheet in Anophthalmic Patients

Superior sulcus deformity is the main cosmetic problem in anophthalmic patients. Many methods of correcting enophthalmos have been reported, especially in patients with orbital wall fracture. The purpose of this study is to review the long term results of effectiveness in superior sulcus deformity correction by subperiosteal Medpor sheet implantation in anophthalmic patients. Subperiosteal Medpor sheets were used in 11 eyes of 11 anophthalmic patients. To estimate the effectiveness, photographs were taken and exophthalmometric value with their own prosthesis using Hertel exophthalmometer was measured in all patients before and after surgery. The overall cosmetic results in superior sulcus deformity were 'excellent' in 3 (27.3%), 'good' in 6 (54.5%), 'fair' in 2 (18.2%). The overall results in enophthalmos were 'excellent' in 3 (27.2%), 'markedly improved' in 4 (36.4%), 'slightly improved' in 4 (36.4%). Most patients had a marked increase in orbital volume, except two patients. They received irradiation treatment in early childhood so showed unsatisfactory results in both superior sulcus deformity and enophthalmos. Subperiosteal Medpor sheet implantation is considered to be a reliable and safe procedure without serious complication and with an excellent cosmetic result.

Exophthalmometric values in a normal Indian population

PURPOSE . The purpose of this study was to establish a set of exophthalmometric values in a normal Indian population and to compute a regression equation for calculating these values. METHODS . Twenty-five-hundred clinically normal Indians of both sexes in the age group of 3–80 years, who did not have local or systemic disease likely to affect orbital or ocular structures, were enrolled in this study. Hertel's exophthalmometer was used to measure the degree of protrusion of the eyes. Statistical methods were used to calculate the mean values in the right and left eye in either sex and to compute a regression equation for calculating the exophthalmometric values. RESULTS . The range of exophthalmometric values in a normal Indian population aged 3–80 years was 7–19 mm for males and 7–21 mm for females. The exophthalmometric values were higher in the first decade, decreased in the second decade, and increased again in the third decade. They then remained stable for the next three to four decades. The peak was reached in the seventh decade in males and in the sixth decade in females. The lowest values in both sexes were attained in the eighth decade. The regression equations for the calculation of the exophthalmometric values are: In males for the right eye: Exophthalmometric value = 12.43 + 0.25 × age; In males for the left eye: Exophthalmometric value = 12.30 + 0.029 × age; In females for the right eye: Exophthalmometric value = 13.30 - 0.003 × age; In females for the left eye: Exophthalmometric value = 13.17 - 0.0003 × age. CONCLUSIONS . The trend of the normal exophthalmometric values for Indian subjects, by and large, was found to be similar to that quoted for other races. A knowledge of the normal values for this population subgroup can help clinicians in the early diagnosis and follow-up of patients with endocrine diseases, orbital tumors, craniofacial trauma and deformities and severe myopia.

The role of enophthalmos in the development of involutional ectropion

Purpose This prospective study was performed to evaluate whether there is an association between enophthalmos and involutional ectropion. Methods Hertel exophthalmometric measurements were obtained from 31 patients with involutional ectropion and from 30 control patients who were age- and sex-matched. Results Eighteen patients had bilateral ectropion and 13 patients had unilateral ectropion. The mean of the exophthalmometric measurements of the eyes with ectropion was 12.67 ± 2.48 (SD) mm. The mean of the exophthalmometric measurements of the control patients was 12.80 ± 2.87 (SD) mm in the right eye and 12.83 ± 2.93 (SD) mm in the left eye. The difference between the eyes of the patients and the controls was not statistically significant (p>0.05). In the affected eyes of the patients with unilateral ectropion, the mean exophthalmometric value was 13.15 ± 2.51 (SD) mm, and in the unaffected eyes of the patients, the mean exophthalmometric value was 13.07 ± 2.56 (SD) mm. This difference was not statistically significant either (p>0.05). Conclusion Patients with involutional ectropion do not have more enophthalmos than the age- and sex-matched normal population. This study does not suggest an association between enophthalmos and involutional ectropion.