Unilateral Proptosis- A Tertiary Care Experience

Abstract

Introduction Proptosis is defined as forward protrusion of eye in relation to skull. It could be resulting from a variety of causes. Proptosis could be unilateral, bilateral, acute, intermittent or pulsating in nature. It is difficult to diagnose a case of proptosis as it not only involves orbit but also the surrounding structures and are inaccessible to routine methods of examination. Since a case of proptosis could be due to variety of causes, early identification of aetiology is crucial as it could be vision and life threatening. Methods: This is a observational study of twenty cases with unilateral proptosis of different age groups over a period of 1 year. Proptosis was measured using simple ruler exophthalmometry and patients with readings more than 21 mm or a difference of more than 2mm between both eyes were included in this study. Different specialists including neurosurgeon, radiologist and ENT surgeon opinion were sought. The diagnosis was made after a complete clinical examination, radiology and histopathology report. Results: In this study of 20 patients all patients were above 20 years of age with the majority in the age group of 50-59 years. Male preponderance was noted with most of them presenting with left sided proptosis. Swelling and eye pain were the major chief complaints among the patients. Orbital cellulitis and Rhinoorbital mucormycosis were the major causes of unilateral proptosis in our study accounting for about 20% of cases each. Majority of patients were managed surgically (45%) followed by medical management (30%) and combination of surgical and medical management (25%). Conclusion: The cause of proptosis does not correspond to a single disease but rather to a variety of diseases. Hence it is important to do a thorough clinical examination as well as radiological scans and histopathology to confirm the diagnosis. This helps with appropriate and timely management of a case of proptosis.