EXOPHTHALMOS

Ask the following questions:

1. Is it bilateral or unilateral? Bilateral exophthalmos would suggest hyperthyroidism. Unilateral exophthalmos suggests orbital tumor, abscess, or aneurysm.
2. If it is bilateral, are there signs of hyperthyroidism? If there are other indications of hyperthyroidism, Graves' disease would be the diagnosis.
3. If it is unilateral, does the eyeball pulsate? A pulsating eyeball would suggest an arteriovenous fistula, and there should be a loud blowing murmur over the orbit.
4. Is there fever? Fever would suggest acute cellulitis, acute sinusitis, periostitis, or a cavernous sinus thrombosis.
5. Is there chemosis or ecchymosis? These signs are suggestive of a cavernous sinus thrombosis.

DIAGNOSTIC WORKUP

In cases of bilateral exophthalmos, particularly if there is no fever or chemosis or ecchymosis, a thyroid profile is the most valuable test. Orbital MRI may also be done. However, Graves' disease may be present with normal thyroid function tests. Testing for thyrotropin receptor antibody and peroxidase antibodies should be done in these cases. Other endocrine studies may be necessary once hyperthyroidism has been excluded. In cases of unilateral exophthalmos, ultrasonography and plain films of the orbits and sinuses may be helpful, but a CT scan of the brain and sinuses is the most valuable diagnostic aid. Carotid angiography will need to be done to diagnose an arteriovenous fistula.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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