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protrusion of the eyeball from the socket

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2018/01/24 23:31:58」(JST)

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Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in an orbital tumor). Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma.

In the case of Graves' disease, the displacement of the eye is due to abnormal connective tissue deposition in the orbit and extraocular muscles which can be visualized by CT or MRI.^[1]

If left untreated, exophthalmos can cause the eyelids to fail to close during sleep leading to corneal dryness and damage. Another possible complication would be a form of redness or irritation called "Superior limbic keratoconjunctivitis", where the area above the cornea becomes inflamed as a result of increased friction when blinking. The process that is causing the displacement of the eye may also compress the optic nerve or ophthalmic artery, leading to blindness.

Measurement

Measurement of the degree of exophthalmos is performed using an exophthalmometer.

Most sources define exophthalmos/proptosis as a protrusion of the globe greater than 18 mm.^[1]

The term exophthalmos is often used when describing proptosis associated with Graves' disease.^[2]

Anatomy

Proptosis is the anterior displacement of the eye from the orbit. Since the orbit is closed off posteriorly, medially and laterally, any enlargement of structures located within will cause the anterior displacement of the eye.^[3] Swelling or enlargement of the lacrimal gland causes inferior medial and anterior dislocation of the eye. This is because the lacrimal glands are located superiorly and laterally in the orbit.^[3]

Causes

Inflammatory/Infection:

Graves' ophthalmopathy due to Graves' disease, usually causes bilateral proptosis.
Orbital cellulitis – often with unilateral proptosis, severe redness, and moderate to severe pain, sinusitis and an elevated white blood cell count.^[4]
Dacryoadenitis
Erdheim-Chester Disease
Mucormycosis
Orbital pseudotumor – presents with acute, usually unilateral proptosis with severe pain.^[4]
High altitude cerebral edema
Granulomatosis with polyangiitis

Neoplastic:

Leukemias
Meningioma, (of sphenoid wing)
Nasopharyngeal angiofibroma
Hand–Schüller–Christian disease
Hemangioma, cavernous

Cystic:

Dermoid cyst

Vascular:

Carotid-cavernous fistula
Aortic insufficiency: manifests as a pulsatile pseudoproptosis, described by British cardiothoracic surgeon, Hutan Ashrafian in 2006

Others:

Orbital fracture: apex, floor, medial wall, zygomatic
Retrobulbar hemorrhage: trauma to the orbit can lead to bleeding behind the eye. The hemorrhage has nowhere to escape and the increased pressure pushes the eye out of the socket, leading to proptosis and can also cause blindness if not treated promptly.
Cushing's syndrome (due to fat in the orbital cave)
Pfeiffer syndrome

Animals

Exophthalmos in a Pug

Exophthalmos is commonly found in dogs. It is seen in brachycephalic (short-nosed) dog breeds because of the shallow orbit. However, it can lead to keratitis secondary to exposure of the cornea. Exophthalmos is commonly seen in the Pug, Boston Terrier, Pekingese, and Shih Tzu.

It is a common result of head trauma and pressure exerted on the front of the neck too hard in dogs. In cats, eye proptosis is uncommon and is often accompanied by facial fractures.^[5]

About 40% of proptosed eyes retain vision after being replaced in the orbit, but in cats very few retain vision.^[6] Replacement of the eye requires general anesthesia. The eyelids are pulled outward, and the eye is gently pushed back into place. The eyelids are sewn together in a procedure known as tarsorrhaphy for about five days to keep the eye in place.^[7] Replaced eyes have a higher rate of keratoconjunctivitis sicca and keratitis and often require lifelong treatment. If the damage is severe, the eye is removed in a relatively simple surgery known as enucleation of the eye.

The prognosis for a replaced eye is determined by the extent of damage to the cornea and sclera, the presence or absence of a pupillary light reflex, and the presence of ruptured rectus muscles. The rectus muscles normally help hold the eye in place and direct eye movement. Rupture of more than two rectus muscles usually requires the eye to be removed, because significant blood vessel and nerve damage also usually occurs.^[7] Compared to brachycephalic breeds, dochilocephalic (long-nosed) breeds usually have more trauma to the eye and its surrounding structures, so the prognosis is worse .^[8]

References

^ ^a ^b Owen Epstein; David Perkin; John Cookson; David P de Bono (April 2003). Clinical examination (3rd ed.). St. Louis: Mosby. ISBN 0-7234-3229-5.
^ Mercandetti, Michael. "Exophthalmos". WebMD, LLC. Medscape. Retrieved 6 December 2012.
^ ^a ^b Mitchell, Richard N. "Eye". Pocket companion to Robbins and Cotran pathologic basis of disease (8th ed.). Philadelphia, PA: Elsevier Saunders. ISBN 978-1416054542.
^ ^a ^b Goldman, Lee. Goldman's Cecil Medicine (24th ed.). Philadelphia: Elsevier Saunders. p. 2430. ISBN 1437727883.
^ "Prolapse of the Eye". The Merck Veterinary Manual. 2006. Retrieved 2007-03-23.
^ Gelatt, Kirk (2002). "Treatment of Orbital Diseases in Small Animals". Proceedings of the 27th World Congress of the World Small Animal Veterinary Association. Retrieved 2007-03-23.
^ ^a ^b Gelatt, Kirk N. (ed.) (1999). Veterinary Ophthalmology (3rd ed.). Lippincott, Williams & Wilkins. ISBN 0-683-30076-8.
^ Bjerk, Ellen (2004). "Ocular Injuries in General Practice". Proceedings of the 29th World Congress of the World Small Animal Veterinary Association. Retrieved 2007-03-23.

External links

Can the human eyeball be knocked out of the head? at Straight Dope.
What Is Exophthalmos? What Causes Exophthalmos? at Medical News Today. Accessed 2013-12-22.

UpToDate Contents

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Pathological findings of Japanese Black Cattle living in the restricted area of the Fukushima Daiichi Nuclear Power Plant accident, 2013-2016.

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Japanese Journal

Use of a superficial temporal vein approach for transvenous embolization of a cavernous sinus dural arteriovenous fistula: a case report

, , , , , , , , , , ,
脳神経血管内治療 9(2), 90-95, 2015
… We describe a case of CS-dAVF successfully treated with TVE via the superficial temporal vein (STV) from the common femoral vein.<br/>Case presentation: The patient was an 82-year-old woman with conjunctival hyperemia and exophthalmos of the left eye due to a left CS-dAVF. …
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Use of a superficial temporal vein approach for transvenous embolization of a cavernous sinus dural arteriovenous fistula: a case report

, , , , , , , , , , ,
脳神経血管内治療 advpub(0), 2015
… We describe a case of CS-dAVF successfully treated with TVE via the superficial temporal vein (STV) from the common femoral vein.<br/>Case presentation: The patient was an 82-year-old woman with conjunctival hyperemia and exophthalmos of the left eye due to a left CS-dAVF. …
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山内利宏,古口徳雄,松浦威一郎 [他],木島裕介,相川光広,鈴木浩二,宮田昭宏,小林繁樹
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Related Pictures

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★リンクテーブル★

リンク元	「眼球突出」「infiltrative」「拍動性眼球突出」「proptosis」「眼球突出症」
拡張検索	「endocrine exophthalmos」「exophthalmos without hyperthyroidism」

「眼球突出」

Exophthalmos
	Patient with left eye proptosis
Classification and external resources
Specialty	ophthalmology
ICD-10	H05.2
ICD-9-CM	376.2-376.3
DiseasesDB	18612
MedlinePlus	003033
eMedicine	oph/616
Patient UK	Exophthalmos
MeSH	D005094
	[edit on Wikidata]