Benign+Exophthalmos


 * **Epidemiolgy:** || Proptosis due to any cause can compromise visual function and the integrity of the eye, a difference of 2 mm is considered abnormal.1 ||
 * **Etiology:** || Globe protrusion differs in groups of the population based on age, race and sex. I could not find evidence that any of these groups are more prone to the condition than others.1 ||
 * **Signs & Symptoms:** || A difference in eye protrusion of more than 2mm is considered exophthalmos, symptoms of proptosis can include:1
 * Disruption of the tear film layer
 * Incomplete moisturizing of the eye
 * Epithelial death
 * Ulceration
 * Corneal perforation(in severe cases)
 * Neuronal death
 * Diminished optic nerve function
 * Depresion of visual and color acuities
 * Pupillary dysfunction
 * Contriction of visual feild ||
 * **Diagnostic Procedures:** || Laboratory Studies:1
 * Patients with thyroidopathy should undergo the appropriate thyroid function studies,
 * Any patient suspected of having a neoplasm as the cause of the proptosis should undergo imaging studies
 * In patients with proptosis due to orbital cellulitis, complete blood counts, blood and nasal cultures, and sinus imaging studies may be warranted.
 * Approximately 80% of those with Graves disease manifest orbital signs within 18 months, supporting the need for ophthalmic evaluation.

Imaging Studies:1 Deep parotid lymph nodes which can be broken down into 2 groups: The first group is embedded in the parotid gland. Its superior border is the TMJ, posterior border is the mastoid process, inferior border is the angle of the mandible, and the anterior border is the anterior ramus. The second group is the subparotid nodes which are located deep to the gland and lie on the lateral wall of the pharynx. Submaxillary lymph nodes which are scattered over the infraorbital region. They are located from the groove between the nose and cheek to the zygomatic arch.
 * CT scan
 * Magnetic resonance imaging (MRI)
 * Ocular ultrasonography can be used to visualize anterior and middle orbital lesions. ||
 * **Histology:** || There is no histology related to exophthalmos itself as it is a benign condition. ||
 * **Lymph node drainage:** || Lymph drainage from the eye is:2

 Buccal lymph nodes which are scattered over the buccinator muscle. ||
 * **Metastatic spread:** || Exophthalmos is a benign disease.3 ||
 * **Grading:** || There is no grading scale for this benign condition.3 ||
 * **Staging:** || There is no staging scale for this benign condition.3 ||
 * **Radiation side effects:** || Typical side effects include eye irritation. Long-term complications are rare, but can include optic neuropathy, retinal injury, and lacrimal gland injury. 4 ||
 * **Prognosis:** || Exophthalmos can lead to inflammation of the cornea, retrobulbar hemorrhaging, and in rare cases, blindness, but is not considered to be life threatening. 4 ||
 * **Treatments:** || Typical treatments include management with corticosteroids and orbital radiation therapy. 4 Radiation therapy is typically delivered at 20 Gy with lateral opposed fields in the range of 4 x 4 to 5.5 x 5.5 cm. 4 ||
 * **TD 5/5:** || TD 5/5 is not associated with exophthalmos, but is with nearby structures.

Retina – 45 Gy Lens – 10 Gy  Optic Nerve – 50 Gy ||
 * **References:** || # <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Expothalmos. Medscape Reference. Available at: []. Accessed on: June 3, 2012.
 * 1) <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Washington CM, Leaver D. Principles and Practice of Radiation Therapy. 2nd edition. St. Louis, MO: Mosby, Inc. 2004: 389.
 * 2) Encyclopedia Britannica. Exophthalmos. Available at: []. Accessed on: July 5, 2012.
 * 3) <span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif;">Hoppe RT, Phillips TL, Mack III M. Leibel and Phillips Textbook of Radiation Oncology. 3rd ed. Philadelphia Pa: Elsevier Saunders; 2010. ||

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