Therefore, immediate veterinary examination and treatment is vital to restoring or saving the dogs eyesight. Late latin proptosis, prolapse, from greek, from propiptein, to fall forward. Pulsatile proptosis from sphenoid wing hypoplasia in. He denied a history of birth trauma or head injury. Pulsatile proptosis and walleyed bilateral internuclear ophthalmoplegia. Pseudoproptosis is either the simulation of abnormal prominence of the eye or a true asymmetry that is not the result of increased orbital contents. Ct showed a large osseous defect of the greater wing of the right sphenoid bone. Exophthalmos can be either bilateral as is often seen in graves disease or unilateral as is often seen in an orbital tumor. Tear size increasing items also increase the maximum distance before disappearance. Proptosis is also known as protruding eyes or bulging eyes in common terms. Pdf pulsatile proptosis due to intraorbital meningocele.
The presence of the characteristic cutaneous findings of neurofibromatosis in this patient along with the characteristic imaging established the diagnosis. The society is dedicated to the improvement of the public health and the advancement of the profession of medicine through education, advocacy and member services. Note lid retraction and exposed sclera above and below cornea. We report the case of a patient with this condition who presented with a previously unidentified sign, namely pulsatile pseudoproptosis.
Proptosis eye disorders msd manual professional edition. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Proptosis definition of proptosis by medical dictionary. The left eye was pulsatile and the pulsatile were synchronous with the carotid pulse video 1. These blood tests can help evaluate the condition of the dog low blood count, organ function. The differential diagnosis of pulsatile proptosis includes absence of the sphenoid wing in patients with neurofibromatosis 1,1 carotidcavernous fistula, orbital roof fractures, and. The veterinarian may want the patient to have skull xrays and chest xrays. Severe proptosis may compromise lid closure and along with lid retraction and tear dysfunction can lead to exposure keratopathy, corneal ulceration and infection. Pulsatile proptosis and walleyed bilateral internuclear ophthalmoplegia november 06, 2018. Analysis of ocular myasthenia gravis and thyroid eye disease. Pulsatile proptosis in neurofibromatosis is due to progressive dysplasia of the sphenoid wing. There was neither proptosis nor enophthalmos hertel exophthalmometry measured 18 mm and 17 mm at 103 base reading.
A complete blood count and a serum chemistry panel may be suggested. Disorders that may cause changes in the appearance of the face and eyes that resemble proptosis but are not include hyperthyroidism without infiltrative eye disease, cushing disease, and severe obesity. Pulsatile pseudoproptosis, aortic regurgitation and 31. Effective range of isaacs tears now also depends on damage, as they can shrink out of existence before their air time runs out. Exophthalmos also called exophthalmus, exophthalmia, proptosis, or exorbitism is a bulging of the eye anteriorly out of the orbit. Preseptal cellulitis orbital cellulitis pseudotumor malignancy trauma page. This typically noticeable and unseemly medical condition is frequently associated with head trauma, and often threatens the dogs vision. On neurological examination, he had a nonsymptomatic, pulsesynchronous pulsatile proptosis of the left eye see video s1 in supplementary material. The differential diagnosis of pulsatile proptosis includes absence of the sphenoid wing in patients with neurofibromatosis 1,1 carotidcavernous fistula, orbital roof fractures, and arteriovenous malformations.
A 4 mm pulsatile proptosis was noted, with no direct damage to the eye. If the dog has lost a lot of blood, a blood transfusion may be needed. Some of the other signs of proptosis are discomfort in opening and closing the eyes, difficulty in. Pulsatile exophthalmos or pulsatile proptosis is a clinical symptom characterized by protrusion and pulsation of the eyeball that can occur due to various causes. Proptosis it is axial, unilateral or bilateral, symmetrical or asymmetrical, and frequently permanent. His visual acuity was 2015 in both eyes and his intraocular pressures were normal.
Visual acuity and field were normal, but on closer examination, the retinal arterioles and pupils were pulsatile. Aortic regurgitation is associated with numerous eponymous signs. Proptosis can be confirmed with exophthalmometry, which measures the distance between the lateral angle of the bony orbit and the cornea. According to the patient, this was present since childhood or even birth. Pdf hosted at the radboud repository of the radboud. The clinical presentation of a young adult with complaints of intermittent positional pain and proptosis exaggerated during valsalvatype maneuvers should be initially evaluated with noncontrast ct, for an enlarged superior ophthalmic vein consistent with orbital varices.
We present a patient with pulsatile exophthalmos due to an. Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma. Pulsatile exophthalmos radiology reference article. Autoplay when autoplay is enabled, a suggested video will automatically play next.
Pulsatile proptosis profile eccles health sciences. Proptosis definition of proptosis by the free dictionary. On neurological examination, he had a nonsymptomatic, pulsesynchronous pulsatile proptosis of the left eye see video s1 in supplementary. White color is visibly seen on the area between the iris and the upper eyelid if a person has bulging eyes. A 44yearold man with neurofibromatosis type 1 had been aware that his right eye pulsated. Shows left eye pulsating back and forth with the pulse from front. Example of a patient with neurofibromatosis with an absent sphenoid wing. The differential diagnosis of pulsatile proptosis includes orbital roof fractures, encephaloor meningoceles, neurosurgical procedures, neurofibromatosis type 1, and vascular malformations. Members of the rhode island medical society include medical doctors, osteopathic physicians, physician assistants. Pulsations may be quite pronounced, but the vision is rarely affected. Proptosis may best be appreciated clinically when the examiner looks up from below with the patients head tilted back the socalled wormseye view.
Proptosis eye disorders merck manuals professional edition. The treatment for eyes that are bulging depends heavily on the cause which is underlying this problem. Beware the pulsatile proptosis emergency medicine journal. Published by rachel mathes davis, dvm, ms, dacvo july 2016 publication. Pulsatile proptosis due to intraorbital meningocele ncbi. Proptosis is the sudden expulsion of the globe from the orbit causing the globe to be positioned anterior to the eyelids and the eyelids to become entrapped posterior to the globe. Exophthalmos means the same thing, and this term is usually used when describing proptosis due to graves disease.
Proptosis is a medical condition which causes a dogs eye to move forward. A thoracoabdominal trauma ct series ruled out aortic dissection and traumatic injury to any abdominal viscus. Eyes dont just bulge out for no reason so it is probably safe to say that there is some very serious problem hanging around in the background. Active ted lasts for up to three years and is characterized by inflammation and tissue expansion behind the eye. He had no history of congenital anomalies, bone dysplasia, or neurofibromatosis. Veterinary information network vin disease description. A 79yearold man presented with a transient ischemic attack of the posterior circulation. Pdf a mysterious posttraumatic pulsatile exophthalmos. Up next examination of the eyes and vision osce guide duration.
Cases of proptosis develop for reasons ranging from variations in our anatomy to the development of another condition such as hyperthyroidism, of which bulging eyes are a symptom. Isaacs tears become larger and do more damage, but shrink and do less damage the farther they travel. The rhode island medical society is the professional association of rhode island doctors in all medical specialties. Proptosis, or exophthalmos, is the bulging out of one eye unilateral or both eyes bilateral.