眼眶肿瘤眼球突出952例

目的 探讨眼眶肿瘤致眼球突出的临床特征及相关因素。方法 总结门诊住院的眼眶肿瘤致眼球突出患者952例,分析临床表现及影像学检查。结果 952例眼球突出患者中发病较多依次为血管性肿瘤、神经源性肿瘤及泪腺肿瘤等。眼球突出度较正常眼突出2－7mm者最多。突出方向以轴性突出和前下方突出为主。结论 在眼眶肿瘤中血管性肿瘤、神经源性肿瘤及泪腺肿瘤是最常见致眼突的原因。眼突度多为2－7mm ,以轴突及前下方为多,眶内肿瘤和眼腔容积的改变均影响眼球位置。     

静滴高渗脱水剂引起的眶压和眼球突出度变化

目的了解静滴高渗脱水剂后对眼球突出度和眶压的影响，确定眶压及眼球突出度测量在诊断治疗脱水时的价值。方法对86例单眼白内障需手术者，在静滴200g·L(-1)甘露醇前后进行非手术眼的眶压和眼球突出度测量。结果用药后0．5、2、3h眶压和眼球突出度均显著低于用药前。以用药后2h眶压和眼球突出度最低，与用药前比较，眶压下降0．67kPa（P＜0．01）。眼球突出度下降2．1mm（P＜0．01）。结论用高渗脱水剂可使眶内组织脱水，使眶压和眼球突出度降低，用直接接触式眶压计可同时检测出这种脱水引起的眶压和眼球突出度变化，为诊断治疗脱水提供依据。     

Recognizing the Protruding Eye

It is currently unknown how much exophthalmos may be noticeable to an observer. The authors determined the threshold for detection of exophthalmos may be 4 millimeters. Purpose: To determine the threshold for detection of exophthalmos by an observer. Methods: The Massachusetts Eye and Ear Infirmary Ophthalmic Plastics imaging database was used to select 28 photographs of patients with unilateral exophthalmos measuring between 1 to 11 mm for the study group and 28 photographs of patients without exophthalmos for the control group. One hundred ophthalmology attendings, residents, medical students, and technicians reviewed each photograph. Participants commented on whether the patient appeared “normal” or “abnormal.” Results: Eighty-one percent of the control patients were correctly identified as “normal.” In comparison, 60% of patients with 1 mm of exophthalmos (p < 0.001), 53% of patients with 2 mm of exophthalmos (p < 0.001), 46% of patients with 3 mm of exophthalmos (p < 0.001), 35% of patients with 4 mm of exophthalmos (p < 0.001), and 40% of patients with 5 mm of exophthalmos (p < 0.001) were identified as “normal.” The vast majority of patients (91.9%, p < 0.001) with 6 mm of exophthalmos were identified as “abnormal,” and almost all patients (97.9%, p < 0.001) with more than 6 mm of exophthalmos were also described as having an “abnormal” appearance. Conclusions: Greater than half of the patients with 1–2 mm of exophthalmos appear as “normal” as the control patients. In comparison, the majority of patients with 4–5 mm of exophthalmos and nearly all the patients with 6 mm of exophthalmos and greater appear “abnormal.” Our data suggests that the point at which exophthalmos becomes clinically perceptible to the majority of observers is 4 mm. There may be patients with 3 mm of exophthalmos and greater with orbital pathology being “missed” on cursory external examinations by general ophthalmologists, optometrists, and general practitioners.     

Original acquisition in the pathogenesis and the treatment of endocrine ophthalmopathy

In the present work, we demonstrate in the serum of patients with progressive exophthalmos, the presence of circulating immunoglobulin which is able to induce an experimental exophthalmos in goldfish. This immunoglobulin disappears when exophthalmos becomes residual. In parallel, we describe an easy technique for the measurement of delayed hypersensitivity which is positive for thyroid or retroorbital antigens in progressive exophthalmos but negative in residual exophthalmos. We also demonstrate in patients with exophthalmos an increase in urinary glycosaminoglycans. We propose a new therapeutic approach in treatment of acute exophthalmos which consists of intensive plasma exchange followed during a few months, by the administration of small amounts of corticosteroids. The plasma exchange mechanism consists of the extraction of the antibody directed against retroorbital eye muscle antigen. In addition, plasma exchange produces the extraction of glycosaminoglycans from retroorbital tissue. These hygroscopic molecules are responsible for the marked oedema in retroorbital tissue.     

眼眶病患者眼球突出度与眶压比值的研究

目的了解眶内占位性病变为固体、液体或气体时眼球突出度与眶压比值的差异。方法用直接接触式眶压计对５０例眼眶病患者进行眼球突出度及眶压测量,计算眼球突出度与眶压的比值。结果眶内占位性病变为固体时眼球突出度与眶压的比值最低,为交通性液体时最高。结论测量眼球突出度与眶压的比值可为诊断眶内占位性病变的性质提供依据。     

Orbital decompression in Graves-Basedow disease--preliminary report

The aim of the paper is to present our initial experience in surgical treatment of patients with malignant exophthalmos. MATERIAL AND METHOD: from 2001 to 2004, 11 patients with malignant exophthalmos were treated in our Department. Preoperative exophthalmos ranged from 22 to 40mm, asymmetric exophthalmos was diagnosed in 5 cases. Orbital decompression was indicated in patients with ophthalmopathy (11), decreased visual acuity (4), lagophthalmos (3). Decompression included orbital floor, medial and lateral wall in 8 patients, orbital floor and medial wall in 3. RESULTS: in 5 patients exophthalmos decreased 5-8 mm, in 5 cases 2-3 mm, 1 patient remained without improvement. CONCLUSIONS: 1. The treatment of malignant exophthalmos requires multidisciplinary approach. 2 Orbital decompression should be followed by surgical correction of eyelids and eyeball muscles.     

CT features of exophthalmos in Chinese subjects with thyroid-associated ophthalmopathy

AIM:To investigate computed tomography (CT) features of exophthalmos in Chinese subjects with thyroid-associated ophthalmopathy (TAO).METHODS:A total of605 eyes of 325 patients with exophthalmos due to TAO were classified as grade I (mild exophthalmos) or II (severe exophthalmos) based on orbital CT imaging. The increased orbital volume features, such as changes from extraocular muscles, orbital fat, or both, were analyzed.RESULTS: A total of 605 eyes were analyzed, among them 62.98% presented grade I exophthalmos, while 36.02% showed grade II exophthalmos.#$TAB In grade I, 56.69% showed orbital fat change, and in grade II, 89.29% exhibited extraocular muscle enlargement.CONCLUSION: Orbital fat and extraocular muscle enlargement are likely to be observed on CTs of subjects with mild and severe exophthalmos, respectively. Our results suggest that CT findings may guide TAO clinical therapy recommendations and prognosis.     

青年女性瞳距、眼球突出度与近视眼关系分析

目的:了解青年女性瞳距、眼球突出度正常值及两者与近视眼关系,并为青年女性眼镜配戴提供瞳距参考值。方法:采取整群抽样的方法,对本校18~19岁女性学生进行视力、瞳距、眼球突出度与屈光状态检查。结果:1105名受检青年女性中,视力正常组与近视眼组的瞳距均值分别为59.27,59.35mm,两组瞳距比较经统计学处理无差异性存在;眼球突出度均值视力正常组为15.49mm,近视眼组为15.76mm;视力正常眼,轻度、中度、高度近视眼各组人群测定眼球突出度经方差分析比较有显著性差异(F=6.108,P<0.01),4组人群眼球突出度经LSD处理后两两比较:视力正常眼与中、高度近视眼,高度近视眼与轻、中度近视眼等4组之间均有显著性差异(P<0.05);各组眼球突出度左、右眼间比较,差异均无显著性。结论:青年女性瞳距、大小并不随近视度数增加而改变,但眼球突出度与近视眼之间存在一定的关系,即近视眼随着眼轴延长近视屈光度增加,其眼球突出度亦随之增加。     

Exophthalmos in systemic lupus erythematosus

In systemic lupus erythematosus (SLE) exophthalmos is distinctly rare. This article describes the first patients with SLE in whom exophthalmos was preceded by pseudotumor cerebri. The apparent lack of resolution of the exophthalmos with corticosteroids in our case emphasizes the potential need for therapeutic alternatives such as immunosuppressive agents, orbital irradiation, and/or plasmapheresis.     

Exophthalmos of patients with Graves' disease in Chinese of Taiwan

PURPOSE: To determine the exophthalmos measurements in patients with Graves' disease (GD) and to compare with those of normal subjects among the Chinese of Taiwan. METHODS: Hertel's exophthalmometry were performed in 163 consecutive adult GD patients and 419 normal subjects. The values of exophthalmos, asymmetry, and the distance between lateral orbital rims (base) were evaluated. RESULTS: There was a significant difference between GD and normal adults for exophthalmos and asymmetry, with GD patients demonstrating a mean exophthalmos of 18.32 mm and asymmetry of 0.93 mm as compared with 13.91 and 0.55 mm for normal subjects (P<0.001). The mean value of base for GD adults (106.52 mm) is slightly greater than normal subjects (105.82 mm). There was no gender difference in exophthalmometric value or asymmetry in each group. A total of 79 (48.5%) GD patients had exophthalmos greater than the upper limit of normal Chinese in Taiwan (18.6 mm). Asymmetry over 2 mm was observed in 11 (6.7%) patients with GD but in none of the normal subjects. CONCLUSIONS: GD patients have significant exophthalmos and asymmetry compared to normal subjects. In comparison with previous studies, exophthalmos values for Chinese in Taiwan tend to be lower than those of Caucasians and black-American people, but are close to those of Korean, Japanese, Iranian, Indian, and Asian-American people. Adequate adjustment of normal and abnormal values of exophthalmos according to individual differences is important for the diagnosis of orbital morbidity and management of thyroid associated orbitopathy.     

900名青年女性眼球突出度测定及其与近视眼关系分析

目的 了解青年女性眼球突出度及其与近视眼关系。方法 采用整群抽样的方法，对本校18—19岁女性进行眼球突出度与屈光状态检查。结果 900名受检青年女性中，视力正常眼与近视眼两组眼球突出度左、右眼间比较，差异均无显著性；视力正常眼，轻度、中度、高度近视眼各组测定人群眼球突出度经方差分析比较有显著性差异(F＝4．678，P＜0．05)，四组人群眼球突出度经LSD处理后两两比较：视力正常眼与中、高度近视眼，高度近视眼与轻、中度近视眼等四组之间均有显著性差异(P＜0．05)。结论 眼球突出度与近视眼之间存在一定的关系，即近视眼随着眼轴延长近视屈光度增加，其眼球突出度亦随之增加。     

Unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy: benign exophthalmos syndrome (BES). A description of a new clinical condition

PURPOSE: To report the clinical and radiologic characteristics of a group of patients who experienced unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy. The clinical features of these patients are presented and a hypothesis proposed to explain this condition for which the authors introduce the term benign exophthalmos syndrome (BES). METHODS: Retrospective, noncomparative case series. Participants: Four patients experienced slow progressive unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy, with no evidence of orbital mass or extraocular muscles involvement. Intervention: Main Outcome Measures. Symptomatic outcome and measurement of the degree of relative exophthalmos. RESULTS: The onset of exophthalmos was associated with clinical and radiologic features that resemble BES. In all patients, radiologic examination demonstrated an ipsilateral mucosal turbinate hypertrophy and not the presence of orbital disease or expanding lesions of paranasal sinus. After daily intranasal spray of steroid, in three of the four cases the globe returned to within 1 mm of exophthalmometry of the contralateral eye. CONCLUSIONS: The relationship between the feature of paranasal sinus disease and the development of ipsilateral exophthalmos has been described in the literature. The four cases described herein appear peculiar for the slow progressive onset of the exophthalmos, without inflammatory and mass effect signs. This condition associated in all cases with ipsilateral hypertrophy of the nasal mucosa provides a guide to a hypothetical mechanism for BES. According to these hypothesis, the therapy should be devoted to the nasal disease more than the orbital.     

583例眼眶病致眼球突出的病因分析

目的 了解引起眼球突出的眼眶病的病因分类及分布状态.方法 回顾性系列病例研究.分析第四军医大学西京医院1960-2008年收治的所有住院患者的病历资料,收集病历中记载有眼球突出的病例,排除其中资料不完整,诊断不明确的病例.共收集到583例患者的临床资料,对患者的性别、年龄、引起眼球突出的病因、临床表现、辅助检查进行分析.对资料进行分类计数,求百分比.结果 引起眼球突出的病因可分为5类,即肿瘤(58.3％)、甲状腺相关眼病(21.4％)、炎症性疾病(17.2％)、外伤(2.7％)和遗传及发育性疾病(0.3％).根据来源可将肿瘤分为眶内起源肿瘤(72.9％)、副鼻窦肿瘤眶蔓延(18.5％)、造血系统肿瘤(4.1％)、颅脑肿瘤眶蔓延(3.2％)、眼内肿瘤眶蔓延(0.6％)和转移癌(0.6％).引起眼球突出的常见病因依次为甲状腺相关眼病(21.4％)、海绵状血管瘤(11.2％)、炎性假瘤(10.3％)、良性脑膜瘤(6.5％)、静脉性血管瘤(6.0％)、眶蜂窝织炎(5.3％)、皮样及表皮样囊肿(4.6％)、神经鞘瘤(3.6％)、鳞癌(2.9％)和多形性腺瘤(2.7％)等.引起儿童眼球突出的病因依次为血管瘤、眶蜂窝织炎、皮样及表皮样囊肿、脑膜瘤、炎性假瘤、神经鞘瘤、神经胶质瘤、神经纤维瘤、甲状腺相关性眼病和横纹肌肉瘤等.结论 眼球突出可由各种眼眶病引起,单侧眼球突出病因依次为肿瘤、甲状腺相关眼病、炎症等,双侧眼球突出病因以甲状腺相关眼病最多见,成人与儿童眼球突出常见病因不同,儿童以血管瘤多见,成人以甲状腺相关眼病多见.     

CD4＋CD25＋调节性T细胞在Graves眼病患者外周血中的表达

目的：通过检测CIM’CD25’调节性T细胞在Graves眼病患者外周血中的表达,以观察该病患者外周血中CIM’C1~25’调节性T细胞的变化规律。方法：临床实验研究。采用流式细胞术检测对Graves病不伴有眼征患者组（53例）,Graves眼病患者组（51例）,正常对照组（51例）的外周静脉血CD4’CD25’Treg细胞比例进行检测。结果：与正常对照组比较,Graves病不伴有眼征患者组Treg水平下降（P〈0．01）;与正常对照组比较,Graves眼病患者组外周血Treg水平显著下降（P〈0．01）;Graves眼病患者组外周血Treg数量明显低于Graves病不伴有眼征患者组（P〈0．01）。结论：Graves眼病患者外周血中CIM’CD25’Treg在淋巴细胞中所占的比例降低,存在自身免疫调节紊乱。可能是其机体细胞免疫抑制受损的重要机制,为对该疾病进行免疫学治疗提供了新线索。     

Exophthalmia

The authors present the association of signs and symptoms in exophthalmos syndrome, which occurs in many diseases. Although exophthalmos was considered to be of ophthalmological interest, according as researches were made on its pathogeny and according as investigation methods were developed, exophthalmos is no more considered a symptom, but a syndrome. After defining the syndrome, the present study shows its classifications, clinical and complementary investigations, and its treatments.     

眼球突出度的CT测量及其临床意义

目的探讨眼眶CT眼球突出度测量方法与Hertel眼球突出计测量方法之间的关系,及其对眼眶病患者眼球突出诊断中的意义。方法对42例临床资料完整的眼眶病患者的眼球突出度进行回顾性分析。所有病例均进行RB线横轴位2mm薄层螺旋CT扫描。选取眼球最大径层面,在图像工作站上测量其眼球突出度(CT眼突度)。与其临床上采用Hertel眼球突出计测量所得眼球突出度(Hertel眼突度)进行统计学分析。结果两种方法测量眼突度有差异,CT眼突度显著高于Hertel眼突度(P<0.001);两种方法之间有直线相关关系(r=0.864,P<0.001);而两种方法对两眼眼突差的测量,差异无统计学意义(P>0.05)。结论Hertel眼球突出计在测量眼眶病双眼眼突差中常规使用,具有简便可靠的特点。而眼眶CT为眼球突出的测量提供了更直观、准确的数据,有一定的临床价值,可以作为异常眼球突出更精确测量的补充参数,尤其客观地反映了异常眼球突出的程度及提供了治疗前后的影像。     

眼眶减压术治疗30例恶性突眼的疗效观察

目的 评价眼眶减压术治疗严重恶性突眼患者的疗效。方法 采用眼眶减压术治疗30例(34只眼)恶性突眼患者,其中二壁减压术22,只眼,三壁减压术12只眼。术后随访3个月至9年,平均4．5年。观察恶性突眼患者术后视力、眼球突出度、眼球活动度及外观情况。结果 34只眼术后眼睑均能完全闭合。视力：提高25只眼,无改变5只眼,下降4只眼。眼球突出度：二壁减压术后(18．5mm)较术前(22．3mm)明显减小,三壁减压术后(18．6mm)较术前(25．7mm)明显减小。结论 眼眶减压术是治疗严重恶性突眼的有效方法。     

Lipogenic type of edematous exophthalmos: clinical picture, treatment

The authors describe the clinical picture and course of the lipogenic type of edematous exophthalmos. Internal orbital decompression is proposed to use as an alternative technique in the treatment of the lipogenic type of edematous exophthalmos.     

Antibiotic responsive exophthalmos and lateral rectus paralysis.

Sinusitis is an unusual cause of exophthalmos in adults since the advent of antibiotics. Many periorbital complications of sinusitis have been described; however exophthalmos associated with apparent sixth cranial nerve palsy in the absence of ipsilateral sphenoidal sinusitis is a rare and, to our knowledge, unreported complication of sinusitis. We report such a case that was treated with oral antibiotics. We believe that sinusitis must always be considered in adults as a treatable cause of exophthalmos and various orbital complications from isolated lateral rectus paralysis to acute-onset, acquired Brown's syndrome.     

Acute endocrine exophthalmos.

A case is reported of acute endocrine exophthalmos in a 60-year-old clinically euthyroid male diabetic and the rapid response to steroid therapy is described. The exophthalmometer was used to assess objectively the variations of the exophthalmos.