Orbital Disease: Examination and Diagnostic Evaluation

To properly treat orbital disease, it is necessary to establish an accurate diagnosis and to understand the biologic characteristics of the disorder.A systematic method of evaluating patients with exophthalmos and other orbital abnormalities is presented. The most common orbital lesions among adults and children are listed. Abnormalities which mimic exophthalmos and cause pseudoexophthalmos are described.Important features of the history and physical examination of patients with orbital diseases are given. A comprehensive outline is described for the evaluation of patients who may have ophthalmic Graves' disease. A logical sequence is presented in which initial orbital studies (roentgenograms, ultrasonography, and computed tomography) and secondary orbital studies (radionuclide scans, venography, and arteriography) should be performed. Examples are given of three-dimensional computed tomography, using both axial and coronal scans. Finally, special diagnostic studies that can be performed upon excised tissue (electron microscopy, cell surface immunology, hormone receptor assay, and tissue culture) are discussed.