Is exophthalmos unilateral or bilateral? Inflammatory or non-inflammatory bilateral non-inflammatory exophthalmos are mostly endocrine exophthalmos, followed by hematopoietic tumors-green tumors are rare, such as congenital orbital malformation (pointed malformation), bilateral inflammatory exophthalmos are seen in pseudotumor cavernous sinus thrombosis, unilateral inflammatory exophthalmos are seen in orbital cellulitis, orbital periostitis, pseudotumor dacryocystitis, and unilateral non-inflammatory exophthalmos are more common in orbital tumors, including benign and malignant tumors, with rapid development, severe pain, eyelid edema and edema.

History of disease

Ask about the medical history in detail, and whether there is red pain in the eyes from the onset time. The relationship between the location of red pain and exophthalmos is fast or slow. Do you have a history of unilateral or bilateral injuries, especially head injuries? The possibility of arteriovenous fistula should be considered.

physical examination

A general physical examination is very important. It is necessary to check the endocrine and blood system that can cause exophthalmos, and pay attention to whether there is inflammation in the paranasal sinuses and whether the tumor has primary tumors of other organs.

Eye examination: Pay attention to measuring vision, whether the width of palpebral fissure is smooth, whether there is a mass around the orbit, whether the eyelid conjunctiva is swollen and congested, whether there is eye movement, whether there is pulsation and posture relationship in the protruding direction, whether there is noise, and whether there is a mass with elastic texture, which may be cyst, hemangioma, meningocele, hard tumor and pseudotumor. Most tumors inside are mucinous cysts. Lacrimal gland tumor and dermoid cyst should be considered. When exophthalmos, glioma, neurofibroma, sphenoid bone and other early central visual impairment occur.

3. Inspection fee

Thyroid function examination is helpful to distinguish endocrine exophthalmos. Serum thyroxine (T4), triiodothyronine (T3) and thyrotropin (TSH) should be determined.

Hemogram examination includes peripheral hemogram and bone marrow examination, tumor puncture or biopsy.

Four instrument inspection

(a) measurement of spherical protrusion

Exophthalmos refers to the vertical distance between the vertex of cornea and the outer edge of both sides of orbit, which can be measured by Hertel exophthalmos meter.

(2) Image inspection

X-ray examination can show the changes of bone and orbital cavity and optic canal. Benign tumors can enlarge the orbit due to the long-term increase of orbital pressure, suggesting that hemangiomas and meningiomas of retinoblastoma can have calcification points on plain films of malignant tumors, suggesting that retinoblastoma has metastasized to the brain through the optic nerve. Glioma or optic nerve sheath meningioma can also have this manifestation. Ultrasonic exploration can show the fatty optic nerve in orbit with good soft tissue resolution. Extraocular muscle and superior ophthalmic vein, such as multiple extraocular muscle hypertrophy muscle, have more echoes, which are often Graves' disease. The weak echo or anechoic region in the strong echo light cluster can be used as the diagnostic standard of tumor. CT scanning has high density resolution and spatial resolution. Orbital lesions such as tumor inflammation and vascular malformation all show high-density shadows, and both intraocular and orbital structures can show magnetism. Vibration imaging is basically the same as CT, and the resolution of soft tissue is better than CTr camera scintillation scanning and ECT, which can observe the metabolic process of cell absorption, utilization and excretion of nuclides. However, DSA selective angiography is rarely used except for metastatic cancer, and it is an essential examination method for diagnosing arteriovenous thinness and observing tumor blood supply.