Orbit Examination

            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:

              •     mass
              •     retropulsion
            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.
            Back to the index for final MRCOphth
            Back to the index for OSCE clinical methods