1. PROPTOSIS IN PEDIATRIC PATIENTS
prospective study by
DR VIJAYLAXMI SHRIVASTAVA
DR G. MALINI
JAWAHARLAL NEHRU HOSPITAL & RESEARCH CENTRE
STEEL PLANT HOSPITAL

2. INTRODUCTION
• ANTERIOR DISPLACEMENT OF GLOBE OF
EYE BY >20 mm
• >2mm DIFFERENCE BETWEEN APEX OF
CORNEA OF TWO EYES
• CHILD WITH PROPTOSIS IS GROTESQUE
TO LOOK AT

3. INTRODUCTION
PERMANENT SEQUELAE
• CORNEAL ULCERATION
• CORNEAL OPACITY
• OPTIC ATROPHY
• BLINDNESS

4. INTRODUCTION
OTOLARYNGOLOGIST
OPTHALMOLOGIST
ONCOLOGIST
RADIOLOGIST PROPTOSIS CLINICIAN
PATHOLOGIST NEUROSURGEON

5. AIMS & OBJECTIVES
TO ANALYSE
• INCIDENCE
• ETIOLOGICAL FACTORS
• CORRELATION WITH
INVESTIGATIONAL MODALTIES
• MANAGEMENT & OUTCOME
OF CHILDHOOD PROPTOSIS

6. MATERIALS & METHODS
• PROSPECTIVE STUDY
• DURATION:THE CALENDER YEAR 2007.
• CASES WITH PROPTOSIS ADMITTED IN
THE PEDIATRICS WARD DURING ABOVE
PERIOD

7. MATERIALS & METHODS
• HISTORY
• EXAMINATION
• INVESTIGATION
• MANAGEMENT
• FOLLOW UP

8. OBSERVATIONS
AGE DISTRIBUTION
2
NUMBER
1
0
6 MONTHS 4 YEAR 8 YEAR 9 YEAR 13 YEAR
MOST CASES WERE TODDLERS - 4/7

9. OBSERVATIONS CONTD
SEX DISTRIBUTION
2
FEMALE
MALE
5
• TOTAL n= 7
• MALE 5/7

10. OBSERVATIONS CONTD:
2
BILATERAL
UNILATERAL
5
• TOTAL n=7

11. PRESENTING COMPLAINTS
7
6
5
4
3
2 5 5
1 3 2
0
HEADACHE PAIN FEVER VOMITING

12. DURATION OF COMPLAINTS
15
14
15
13 12
12
11
10
10
9
8
DAYS 8
7 7
6
5
4 5
3
2
2
1
0

13. PREDISPOSING FACTOR
SINUSITIS-ETHMOIDAL, 3
SPHENOIDAL, & MAXILLARY
FURUNCULOSIS OF NOSE 1
UPPER RESPIRATORY TRACT 1
INFECTION
DENTAL CARIES 1
CONJUCTIVITIS 1

16. SIGNS
7 7
6
5
4 4
4
3 3
3
2
2
1
1
0
LID EDEMA CHEMOSIS MENINGEAL
6 N PALSY 4 N PALSY 3 N PALSY
SIGNS CONVULSI
ON

20. PUPILLARY REACTION
4 3
4/7
NORMAL
DILATED & SLUGGISH REACTION TO LIGHT

21. FUNDUS EXAMINATION
3
3/7
4
NORMAL PAPILLEDEMA

23. INVESTIGATIONS
• HEMOGRAM
• BLOOD CULTURE & SENSITIVITY
• PUS/SWAB CULTURE & SENSITIVITY
• CT SCAN HEAD

24. INVESTIGATIONS
SPECIAL
• COAGULATION PROFILE
• MANTOUX TEST
• ELECTROPHORESIS
• CSF STUDY
• PROTEIN C ,PROTEIN S LEVELS

25. ETIOLOGY
5 3 ORBITAL CELLULITIS WITH
3 3 SINUSITIS WITH CAVERNOUS SINUS
4 THROMBOSIS
ORBITAL CELLULITIS
3
1 RHABDOMYOSARCOMA
2
PROTHROMBOTIC DISORDER
1
0

26. CAVERNOUS SINUS
THROMBOSIS

27. ORBITAL CELLULITIS

28. RHABDOMYOSARCOMA

29. MANAGEMENT
• CONSERVATIVE
• SURGICAL INTERVENTION
• CHEMOTHERAPY

30. CONSERVATIVE MANAGEMENT
• MANAGEMENT OF SHOCK
• AGGRESSIVE ANTIBIOTIC COVERAGE
• TOPICAL ANTIBIOTICS & EYE CARE
• LMWH(ENOXAPARIN)- IN 1 CASE OF
CAVERNOUS SINUS THROMBOSIS
• SUPPORTIVE THERAPY

31. ONCOLOGICL MANAGEMENT
CHEMOTHERAPY
VAC - VINCRISTINE
-ACTINOMYCIN
- CYCLOPHOSPHAMIDE

32. SURGICAL MANAGEMENT
• INCISION & DRAINAGE OF ABSCESS
• CRANIOTOMY & EVACUATION OF PUS
• SINUS DRAINAGE
• EXTRACTION OF CARIES TEETH

33. COMPLICATIONS
COMPLICATIONS RATE OTHER OUR
STUDIES STUDY
VISUAL IMPAIRMENT 10-30% 14%
CAVERNOUS SINUS 40% 42%
THROMBOSIS
NEUROLOGICAL 50% 14%
DEFICIT

35. NO COMPLICATIONS ON FOLLOW UP

36. CRANIAL NERVE PALSY WITH
VISUAL IMPAIRMENT

37. DISCUSSION
STUDY COMPARISON DATA
MALE 2.5:1 AGRAWAL 1.9%
:FEMALE etal(1979)
RATIO
BELMEKKI 2%
(1999)
NAGESWARAN 2.7%.
etal(2006)
SEEMA etal (2006) 1.6%

38. DISCUSSION
STUDY COMPARISON DATA
AGE LESS 57% AGRAWAL 60%
THAN 5 etal(1979)
YEARS
UNILATERA 71% MERCHANT etal 68%
L (1993)

39. DISCUSSION
RISK STUDY COMPARISON DATA
SINUSITIS 42% RODRIQUEZ 68%
etal(2000)
LID & FACE 28 % RODRIQUEZ 28 %
INFECTION etal(2000)

40. DISCUSSION
STUDY COMPARISON DATA
INFLAMMATO 71% SINDHU etal(1998) 39%
RY ETIOLOGY
MAJEKODUNMI 52%.
etal
(NIGERIA 1982)

41. DISCUSSION
STUDY COMPARISON DATA
BLOOD 14% SEAN etal (1998) 10%
CULTURE
GOMEZ 23%
etal(1996).

42. DISCUSSION
STUDY COMPARISON DATA
SURGERY 57% NAGESWARAN etal 71%
(2006).

43. CONCLUSION
• NOT UNCOMMON
• INFLAMMATION FROM ADJACENT SITE
• CAVERNOUS SINUS THROMBOSIS
FREQUENT
HIGH MORTALITY

44. CONCLUSION
• PERMANENT DEFICIT
• PROTHROMBOTIC STATES COEXISTS

45. CONCLUSION
EARLY & PROMPT THERAPY LEADS TO
COMPLETE RECOVERY & SATISFYING
OUTCOME