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   Table of Contents      
Year : 1977  |  Volume : 25  |  Issue : 3  |  Page : 47-52

Normal exophthalmometry

M. U. Institute of Ophthalmology, Aligarh, India

Correspondence Address:
K Nath
M. U. Institute of Ophthalmology, Aligarh
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Source of Support: None, Conflict of Interest: None

PMID: 614274

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How to cite this article:
Nath K, Gogi R, Rao G S, Krishna G, Zaidi N. Normal exophthalmometry. Indian J Ophthalmol 1977;25:47-52

How to cite this URL:
Nath K, Gogi R, Rao G S, Krishna G, Zaidi N. Normal exophthalmometry. Indian J Ophthalmol [serial online] 1977 [cited 2020 Jun 5];25:47-52. Available from: http://www.ijo.in/text.asp?1977/25/3/47/31272

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Table 5

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Table 5

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Table 4

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Table 2

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Table 1

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Table 1

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The term exopthalmometry was coined by Cohn[5]. He designed the first exophthal­mometer in 1865. Thereafter many workers fabricated their own devices to measure the normal prominance of apex of cornea from lateral orbital margins.[1],[2],[4],[6],[11],[13],[15],[17],[18],[20],[21],[22],[24],[25],[27],[33]

The degree of prominance of the eye in normal values of exopthalmometry as recorded by Western workers is shown in [Table - 1]. The normals of Western world are bound to be different from those of Indians. Our own normal exophthalmometric findings very much need investigations. Sethi[28] and Singha et a1[29] investigated the normal values amongst Indians. As their records were not subjected to statistical analysis, the results required fur­ther investigations. The present work includes statistical analysis of normal exophthalmomet­ric readings in 629 persons, and its relationship to sex, age and height.

  Materials and Method Top

629 persons, such as school children, university students, attendants of the patients and out door patients with minor eye ailments were subjected to exophthalmo­metric examination with Hertel's exophthalmometer at M.U. Institute of Ophthalmology, Aligarh. Cases were carefully selected not to have refractive error of more than 0.50 diopter. In all these individuals, the exophthalmo­metric readings were taken by the same person. Measure­ments were taken for both eyes separately in relaxed lying down position. Height was recorded in centi­metres.

Statistical Analysis

At the end of the study the findings were fed in the Computer to find out the following data:

1) Arithmetic mean of exophthalmometric readings for each eye in 629 cases.

2) The values of standard deviation, stan­dard errors and probable error were calculated for each eye separately and `t' test was applied to find out the difference between the two eyes.

3) Relative exophthalmos between the two eyes was calculated in steps of 0.5 mm.

4) Normal range of exophthalmometric readings in males and females was defined.

5) Normal values for males and females were calculated.

6) Cases were sub-divided into different age groups i.e., 5-10, 11-15, 16-20, 21-30, 31-­40, 41-50, 51-60, 61-70, and 71-88 years and readings of each group were treated for arith­metic mean and standard deviation to find the exophthalmometric values in different age groups. These calculations were made separa­tely for each sex and each eye. To find out whether the reading in each group differs statistically from the mean value of the corres­ponding group, `t' test was applied for each eye.

7) To study the relation of height with the extent of normal exophthalmos, all the cases were divided into nine groups from 100 cm to 190 cm in steps of 10.0 cm (i.e., 100, 110, 120, 190). For each group arithmetic mean and standard deviation was calculated and `t' test was applied with the corresponding average means.

  Observation and Comments Top

1) Average mean Exophthalmos

The values of exophthalmometric readings were found to be 14.86 (= + 2.56) mm for the right eye and 14.46 ( + 2.67) mm for left eye with standard probable errors as shown in [Table - 2]. On comparing the normal values of exophthalmos as reported by other workers [Table - 1], it is seen that our normal values are lower as compared to all other workers except Emmert[6], Birch- Hirschfeld[4], and Singha et a1[29]. However, normal reading in West are generally on the higher side than our Indian figures.

2) Range of Exophthalmos

A reading as low as 8.0 mm and as high as 22.0 mm was recorded. Maximum number of patients ranged between 14.0 to 15.0 mm. However, in 80% of the cases the readings varied between 11.0 to 18.0 mm [Figure - 1]. There­fore, a value within this range be considered as normal, a reading between 18.0 to 22.0 mm requires a careful consideration and above 22.0 mm is most likely pathological.

3) Relative Exophthalmos

In 419 persons the readings were equal in both the eyes. A higher reading in right eye was recorded in 193 cases and lower in 17 cases [Table - 3],[Table - 4]. However, taking the overall average, the relative exophthalmos is more in right eye by 0.4 mm and this difference is statistically significant as confirmed by `t' test [Table - 2]. Jackson[15] studied a much larger series (4500 cases) and found relative exophthalmos in 21.0% cases. Whereas Sethi[28] calculated these figures as high as 68% which appears to be misleading as he had studied only a small number of cases.

4) Sex Relationship

[Table - 5] shows that the readings in males are higher as compared to females while the tendency for higher readings of the right eye is maintained. The overall average of right eye in males is higher by 0.84 mm and that of left eye by 0.77 mm, and therefore it can be said that the exophthalmometric values are higher 3/4 of a millimeter (appr.) in males as compa­red to the females.

5) Age Relationship

Different values in various age groups in males and females are plotted on the graph [Figure - 2] &[Figure - 3] and is evident that normal ex­ophtalmometric readings vary considerably in both sexes at different ages. In males higher readings are seen during the second decade and show a gradual decline in the sixth decade [Figure - 2]. However, Singha et al[29] have recorded the highest reading in the fourth decade. In females, like males, the exophthal­mometric readings are maximum during second decade when hormonal activity is at zenith, and start declining in the fifth decade as do the hormones [Figure - 3]. Hence, the normal promi­nence of eyes is directly related to the normal play of hormones in both sexes.

6) Height relationship

[Table - 6] shows exophthalmometric values at different heights. Most of the findings are significantly different in various sub-groups of right eye but they bear no relation to the height in cases of the left eye. So no relationship can be drawn between the normal prominence of the eyes and the height. Singha et a1[29] have concluded a direct relationship between height and exophthalmos, which appears to be doubt­ful. Their own readings show that in females the exophthalmometric readings of right eye at the heights of four feet ten inches and five feet seven inches are equal. Similarly in males (left eye) the readings remain the same at five feet one inch and five feet and seven inches. It is therefore concluded that height of an indivi­dual has no relationship with his exophthalmo­metric reading.

  Summary Top

1) A statistical analysis of normal exoph­thalmos was carried out in 629 cases (Normal).

2) An average value found for right eye is 14.86 ( + 2.56) and for left eye is 14.46 ( + 2.67) with a range of 11.0 to 18.0 mm.

3) Values are statistically higher in right eye than left eye in both sexes taken together as well as separately.

4) Relative exophthalmos of right eye is seen in 33.39% of cases.

5) Exophthalmons appears to bear a direct relationship to the hormonal behaviour in both sexes.

6) It has no relationship with height.

  References Top

Ambialet, M, 1903 and 1905, Ann. Oculist, (Paris) 130, 170.  Back to cited text no. 1
Arnold, G, 1928, Klin. Mbl. f. Augen, 80. 656.  Back to cited text no. 2
Birnbaum, 1915, cited by Drews, L.S. 1957, Amer, J. Ophth. 43, 37.  Back to cited text no. 3
Birch-Hirschfeld. A., 1900, Klin.Mbl.Augen., 38, 72.  Back to cited text no. 4
Cohn, H. 1867, Klin. Mbl. Augenh, 5, 339.  Back to cited text no. 5
Drescher, E.P. and Benedict, W.L, 1950. Arch. Ophthal, 44, 109.  Back to cited text no. 6
Drews. L,C, 1957, Amer. J. Ophthal., 43, 37.  Back to cited text no. 7
Galli-Mainini, G, 1942, Ann. Int. Med., 16, 415.  Back to cited text no. 8
Geraud, 1942, Cited by Drews, L.C., 1957.   Back to cited text no. 9
Gormaz, A, 1946, Brit. J. Ophthal., 30, 350.   Back to cited text no. 10
Emmert, E, 1870, Klin. Mbl. Augenh, 8, 33.   Back to cited text no. 11
Helmbold, 1916, cited by Drews, L.C., 1957.  Back to cited text no. 12
Hertel, E, 1905, Arch. Ophthal., 60, 171.  Back to cited text no. 13
Jackson, E, 1903, Amer. J. Med. Sc., 125, 95.  Back to cited text no. 14
Jacksoon, E, 1921, Tr. Sect. Ophth. A.M.A., 1, 56.  Back to cited text no. 15
Knudtson, K, 1949, Acta. Poychs. Neural., 24, 523.  Back to cited text no. 16
Keyser, P, 1870, Arch. f. Augenh., 1, 523.  Back to cited text no. 17
Knapp, P,. 1922, Ztschr. f. Ahgenh., 47, 213.   Back to cited text no. 18
Lee, 1930, Cited by Drews, L.C., 1957.  Back to cited text no. 19
Lohman, W., 1913, Arch. f. Augenh., 75, 85.   Back to cited text no. 20
Lobeck. E., 1942, Arch. f. Ophthal., 144, 383.   Back to cited text no. 21
Luedde, W.H., 1938, Amer. J. Ophthal., 21, 426.   Back to cited text no. 22
Murphey, E., 1943, Arch. Ophthal., 29, 844.   Back to cited text no. 23
Ollers, J., 1948, Nord. Med., 40,2107:  Back to cited text no. 24
Rollet, P. and Durand, 1912, Rev. gen. d. ophthal, 31,193.  Back to cited text no. 25
Ruedemann, A.D., 1936, Cleveland. Clin. Quart. 3,172.  Back to cited text no. 26
Schoenberg, M: J., 1935, Trans. Amer. Ophthal. Soc. 33, 399.  Back to cited text no. 27
Sethi, J.R., 1960. Thesis, cited by Singha et al, 1967.  Back to cited text no. 28
Singha, S,S., Nirankari, M.S. and Kaur, S., 1967, Orient. Arch. Ophthal., 5, 218.  Back to cited text no. 29
Soley, M.H., 1942, Arch. Int. Med., 70,206.  Back to cited text no. 30
Wagener, H.P., 1933, Tr. Amer. Ophthal. Soc., 33, 166.  Back to cited text no. 31
Woods, C.A., 1915, cited by the Drews, L.C., 1957.  Back to cited text no. 32
Zehender, W, 1870, Klin.Mbl. f: Augenth., 1, 183.  Back to cited text no. 33


  [Figure - 1], [Figure - 2], [Figure - 3]

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]


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