Proptosis refers to forward protrusion of the globe with respect to the orbit. There are many causes of proptosis which can be divided according to location and it is worth remembering that it is not just orbital disease processes that cause proptosis.
Exophthalmos also describes forward protrusion of the globe. Several authors use the terms differently, which can be confusing:
- proptosis and exophthalmos are often used interchangeably
- exophthalmos used to refer to severe (>18 mm) proptosis 5
- exophthalmos used to refer to endocrine-related proptosis 6
Enophthalmos is the opposite, displacement of the globe posteriorly.
The causes of proptosis is broad and includes a wide range of mass lesions that originate within the cranium, sinuses, paranasal spaces, and orbit 3:
- thyroid orbitopathy (most common cause of uni/bilateral proptosis in adults)
- orbital cellulitis
- orbital mucocoele
- trauma, e.g. iatrogenic, post-surgical
- vascular lesions
- orbital inflammatory syndrome (also known as orbital pseudotumour)
Assessment of proptosis on cross-sectional imaging is difficult and dependent on the study being acquired in the correct plane:
- the plane of the study must be parallel to the head of the optic nerve and the lens
- the patient must have their eyes open and be looking forward with no eye movement
- the distance from this line to the posterior sclera is normally 9.9 +/- 1.7 mm 2
- the distance from this line to the anterior surface of the globe should be <23 mm 4
The thickness of the extra-ocular muscles can also be used 1.
MRI may also be used in evaluation due to its multiplanar and the inherent contrast capabilities. Use of MR prevents ionizing radiation to orbits. The imaging findings are similar as described above for CT.
- 1. Szucs-Farkas Z, Toth J, Balazs E et-al. Using morphologic parameters of extraocular muscles for diagnosis and follow-up of Graves' ophthalmopathy: diameters, areas, or volumes?. AJR Am J Roentgenol. 2002;179 (4): 1005-10. doi:10.2214/ajr.179.4.1791005 - Pubmed citation
- 2. Nugent RA, Belkin RI, Neigel JM et-al. Graves orbitopathy: correlation of CT and clinical findings. Radiology. 1990;177 (3): 675-82. Radiology (abstract) - Pubmed citation
- 3. Lloyd GA. The radiological investigation of proptosis. Br J Radiol. 1970;43 (505): 1-18. Br J Radiol (citation) - doi:10.1259/0007-1285-43-505-1 - Pubmed citation
- 4. Haaga JR, Boll D. CT and MRI of the whole body. Mosby. (2009) ISBN:0323053750. Read it at Google Books - Find it at Amazon
- 5. Epstein O, Cookson J, Perkin GD et-al. Clinical Examination 3e. Mosby. (2003) ISBN:0723432295. Read it at Google Books - Find it at Amazon
- 6. Garrity JA, Henderson JW. Henderson's Orbital Tumors, 4e. Lippincott Williams & Wilkins. (2007) ISBN:0781738695. Read it at Google Books - Find it at Amazon