The interzygomatic line is a commonly used reference standard for the evaluation of proptosis due to various etiologies on CT/MRI scans.
A horizontal line should be drawn between the most anterior parts of the zygomatic bones in the axial plane.
The normal distance of the interzygomatic line from the posterior sclera:
- 9.9 +/- 1.7 mm (angled parallel to the orbitomeatal plane) 1
- male: 11.2 +/- 4.8 mm (angled -15° to 15° to the orbitomeatal plane)
- female: 10.8 +/- 1.9 mm (angled -15° to 15° to the orbitomeatal plane) 2
Mean length of the line: 103 mm in men and 96 mm in women (angled -15 to 15° to the orbitomeatal plane) 3.
The interzygomatic line can only be used as a reference if the angle of the acquisition relative to the orbitomeatal plane is standardized. Unfortunately various studies haves used different scanning parameters ranging from acquisitions parallel to the orbitomeatal plane 1, to angled axial scans (-15° to 15°) 2-4. Knowledge of this discrepancy between the potential reference standards is crucial, and thus it is also important to perform cross-sectional imaging of the orbits in an internally consistent manner.
Furthermore, it is a good practice to ask patients to keep gazing forward, and to maintain only a gentle eye closure during the scan, in order to avoid globe displacement by the forced contraction of the extraocular muscles 3.
- 1. R A Nugent, R I Belkin, J M Neigel, J Rootman, W D Robertson, J Spinelli, D A Graeb. Graves orbitopathy: correlation of CT and clinical findings. (1990) Radiology. 177 (3): 675-82. doi:10.1148/radiology.177.3.2243967 - Pubmed
- 2. Jong Soo Lee, Dae Won Lim, Sang Hyup Lee, Boo Sup Oum, Hak Jin Kim, Hak Jong Lee. Normative measurements of Korean orbital structures revealed by computerized tomography. (2001) Acta Ophthalmologica Scandinavica. 79 (2): 197. doi:10.1034/j.1600-0420.2001.079002197.x - Pubmed
- 3. A Ozgen, M Ariyurek. Normative measurements of orbital structures using CT. (2013) AJR. American journal of roentgenology. 170 (4): 1093-6. doi:10.2214/ajr.170.4.9530066 - Pubmed
- 4. Vivek Gupta, Anuj Prabhakar, Mukesh Yadav, Niranjan Khandelwal. Computed tomography imaging-based normative orbital measurement in Indian population. (2019) Indian Journal of Ophthalmology. 67 (5): 659. doi:10.4103/ijo.IJO_1187_18 - Pubmed
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