1. Observe
-
lid retraction
-
arterialisation of scleral vessels
2. Confirm proptosis from side and behind and above
3. Measure with Hertel's exophthalmometer
4. Use ruler to assess if proptosis is axial or non-axial
5. Palpate the orbit for:
6. Test ocular motility
7. Other:
-
listen for bruit
-
test optic nerve function
The most common case in orbit examination is thyroid eye disease. However,
do not forget the differential diagnosis of proptosis. The mnemonic VEIN
allows easy recall:
-
V = vascular for eg. cavernous fistula, cavernous haemangioma
-
E = endocrine as in thyroid eye diseases
-
I = inflammatory or infectious conditions such
as orbital cellulits. It is unlikely that you would get acute patient
in fellowship / membership examination
-
N = neoplastic which has a wide differential diagnosis
including optic nerve glioma, meningioma, lacrimal gland tumour or
mucocele from the frontal sinus etc.
|