![]() ![]() Positron emission tomography (PET) allows the assessment of metastatic disease, including leukemia, lymphoma, and metastases from secondary cancers.Īs many cases may present with overlapping clinical features and may provide difficulty in confirming the diagnosis, a tissue biopsy may be necessary to ascertain a definitive answer. Computed tomography (CT) and magnetic resonance imaging (MRI) are the gold standard modalities in evaluating the orbit or cranium for causes of severe infection, mass growth, and foreign bodies related to exophthalmos. Radiological imaging is essential for diagnostic and management purposes. Nasal swabs and blood cultures may be warranted if severe infection is suspected e.g., orbital cellulitis. The white of the sclera is commonly exposed inferiorly to the iris in exophthalmos.Ī full diagnostic workup must include a full screen of blood tests, including complete blood count (CBC), thyroid function and auto-antibody tests, renal function, and C-reactive protein. The clinician should remain at the same level as the patient. It may be accompanied by other extraocular and systemic signs relevant to systemic causes. Clinicians must undertake a full eye examination, assessing a patient's extraocular movements, visual acuity, field assessment, pupil accommodation, and reflexes. Intraocular pressures, anterior segment, and fundoscopy should be performed.Įxophthalmos may be seen on examination and quantified using an exophthalmometer, whereby the extent is measured by the distance from the corneal apex to the midpoint of the anterior rim of the orbit. The examination should include a general examination of the patient to identify any systemic disease such as Graves' disease, leukemia, visceral neoplasm, or constitutional signs that may give rise to suspicion of malignancy. Temporary exophthalmos triggered by the Valsalva maneuver may be consistent with orbital varices. Rapid onset may suggest inflammatory disease, malignant tumors, and carotid-cavernous fistula, while gradual onset implies somewhat benign pathology. The presence of pain may commonly indicate infection (e.g., orbital cellulitis). The rate of onset may provide insight into its etiology. ![]() There may be a history of trauma or constitutional symptoms such as weight loss that may suggest cystic or tumoral growth. Symptoms such as heat intolerance, weight loss, change in bowel habits, and palpitations may support a diagnosis of thyrotoxicosis. A thorough history will help establish the underlying cause. ![]()
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