|Year : 1981 | Volume
| Issue : 3 | Page : 195-197
Surgical management of unilateral proptosis
MS Boparai, RC Sharma
Army Hospital, Delhi Cantt, India
M S Boparai
AMC, Army Hospital, Delhi Cantt
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Boparai M S, Sharma R C. Surgical management of unilateral proptosis. Indian J Ophthalmol 1981;29:195-7
Cases of unilateral proptosis outweigh the bilateral proptosis. Mohan et all found 128 cases to be unilateral out of a total of 138 cases of proptosis. We found only 3 cases to be bilateral out of a total of 43 cases in our study.
| MATERIALS & METHODS|| |
Twenty four cases of unilateral proptosis due to orbital tumours have.been managed by different routes [Table - 1][Table - 2]. [Table - 1] shows the various routes used.
Case No 1. A 33 years Hindu male reported with drooping of the right upper lid and a swelling below the superior orbital margin of 6 months duration. He also noticed the prominance of the eye since the same period.
Examination revealed the right palpabral aperture to be only 7 mm and right eye proptosed by 4 mm and pushed down and out. A tense swelling was palpable in the superomedial quadrant extending into the orbit. Elevation was grossly restricted. Vision and fundus were normal.
Anterior orbitotomy was performed through the eyebrow incision in the supero-medial quadrant. On opening the periosteum a cord like structure was found expanding into a solid dark brown mass which was extending upto the apex of the orbit. Its posterior part was cystic. The growth was removed `in toto'. Histopathology revealed it to be a Schwannoma in connection with the supra orbital nerve. Post operatively the proptosis disappeared, palpebral aperture became normal and there was no visible operative scar.
Case No. 2 : A 24 years male patient reported with gradually increasing swelling over the left eyebrow and upper lid of one duration. He had diplopia of 2 months duration. There was no other relevant past history.
Examination revealed 4 mm proptosis with eye pushed down and out. Left palpebral aperture was only 9 mm compared. to the right aperture of 14 mm. Elevation was grossly restricted. A firm mass was palpable through the medial side of the upper lid.
Anterior orbitotomy was performed and a tense pyocoele originating from the frontal sinus was encountered. It was excised and with the help of the ENT surgeon, the sinus was drained by passing a polythene tube into the nasal cavity. Postoperatively the proptosis disappeared completely and the two palpebral apertures became equal Drainage tube was kept in position till the discharge stopped.
Case No 3 : A 23 years female reported with protrusion of the left eye of 9 months duration. She had mild frontal ache and defective vision of 3 months duration.
Examination revealed an axial proptosis of 5 mm [Figure - 3]. No orbital mass was palpable.
Her vision was 6/12 which over a four weeks period of investigations fell to 6/24. Vision was defective due to the indentation of the eye ball by the orbital space occupying lesion producing chorio-retinal folds.
As the vision was being compromised fast a lateral orbitotomy was performed and a well defined tumour 2.5 x 1.7 x 0.6 cm lying deep in the orbit was removed. Histopathology revealed it to be a mixed lacrimal tumour.
Postoperatively the proptosis disappeared completely and no scar was visible in the straight forward view [Figure - 4]. However a very small faint scar could be made out on the side of the face.
Case No 4 : A 35 years female came with the complaint of gradually increasing proptosis of 2 years duration. There was no pain and vision was not affected.
Examination showed a 7 mm proptosis with the eye ball pushed downwards [Figure - 5]. A mass was palpable in the superolateral quadrant of the orbit.
The tumour was removed by a transfrontal craniotomy. Proptosis disappeared but the patient was left with a visible scar in the forehead postoperatively. She found the shaven head a big embarassment.
Unilateral proptosis is a surgico-ophthalmological problem as orbital tumours are its commonest cause. [Table - 2] shows the incidence of orbital tumours causing unilateral proptosis in this study and in other studies.
Diagnosis and treatment of orbital space occupying lesions requires surgical excision of the orbital mass and its histopathological examination. Orbit due to its situation falls within the domain of the Neuro-surgeon, ENT surgeon and the Ophthalmic surgeon. The majority of cases of unilateral proptosis would appear to have been dealt with by the Neurosurgeon. Logically however an ophthalmologist is better suited to deal with the orbit.
Lateral and anterior orbitotomy are good approaches for removing orbital masses confined to the orbit. Orbitotomy, whether lateral or anterior hardly leaves any appreciable scar postoperatively.
For removal of orbital masses confined to the orbit transfrontal craniotomy should not be employed as it leaves a visible scar in the forehead. Further more a shaven head becomes very embarassing particularly for female patients. Help of the neurosurgeon should be sought in orbital mass extending to the cranium and vice versa. Besides an otorhinolaryngologist must be associated with, when dealing with cases of proptosis the cause of which is an encroachment from the nasal sinuses. Lateral orbitotomy provides ample room to work in the orbit even when the tumour is extending upto the orbital apex.
Majority of the orbital space occupying lesions are amenable to interference by the ophthalmologist.
| Summary|| |
Data in the surgical management of unilateral problems is presented.
| References|| |
Mohan, H. and Sen, D. K., 1971, Proc. All Ind. Ophthalmol. Soc: Vol. XXVIII.
Boparai, M. S., 1977. Med. Jour. Armed Forces, India; Vol. XXXII No. 3.440.
Reese AB quoted by Duke-Elder, S; 1974, System of Ophthalmology, Vol. XIII; Henry Kimpton, London.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
[Table - 1], [Table - 2]