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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).
Boston's sign is the spasmodic lowering of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter. [1]Similar to von Graefe's sign, it is observed in people with Graves-Basedow disease, a type of hyperthyroidism.
It results in the following signs, which can be extremely distressing to the patient: [4] Most frequent are symptoms due to conjunctival or corneal irritation: burning, photophobia, tearing, pain, and a gritty or sandy sensation. [4] Protruding eyeballs (known as proptosis and exophthalmos). Diplopia (double vision) is common. [4]
Differential diagnosis Graves disease Joffroy's sign is a clinical sign in which there is a lack of wrinkling of the forehead when a patient looks up with the head bent forwards. [ 1 ]
Stellwag's sign is a sign of infrequent or incomplete blinking associated with exophthalmos or Graves orbitopathy. It is accompanied by Dalrymple's sign, which is a retraction of the upper eyelids resulting in an apparent widening of the palpebral opening. Stellwag's sign is named after Austrian ophthalmologist Karl Stellwag von Carion.
Abadie's sign of exophthalmic goiter is a medical sign characterized by spasm of the levator palpebrae superioris muscle with retraction of the upper lid (so that sclera is visible above cornea) seen in Graves-Basedow disease which, together with exophthalmos causes the bulging eyes appearance. [1] It is named for Jean Marie Charles Abadie. [2] [3]
Optic nerve gliomas have low mortality but extremely high prevalence of vision loss and eye-bulging exophthalmos) in children. [4] As of 2014, approximately 1000 cases had been reported. [ 4 ]
In children and teenagers mean exophthalmometric measurements increase with age: Less than 4 years old (13.2 mm), 5–8 years old (14.4 mm), 9–12 years old (15.2 mm) and 13–17 years old (16.2 mm). [4] Axial Length of the eye affects exophthalmometer reading. Pseudoproptosis may be seen in severe myopia. [5]