Acute lymphoblastic leukemia all, a common hematological malignancy observed in children, typically presents with fever, pallor, easy bruising. Proptosis is defined as abnormal protrusion of the eye due. Another resource suggests that the terms exophthalmos and proptosis can be used to describe eyes appearing to bulge out of the face due to an increase in the volume of the tissue behind the eyes. A 58yearold caucasian woman presented to our hospital with a 2week history of diplopia and proptosis of the left eye. Treatment of proptosis general lubricants taping eyelids cold compresses page 32 proptosis in adults mar 25, 20 33. Exophthalmos also called exophthalmus, exophthalmia, proptosis, or exorbitism is a bulging of the eye anteriorly out of the orbit. Orbital infiltration with bilateral proptosis has been observed in 2% cases of acute or chronic lymphatic leukaemia. Orbital cellulitis and malignancies are considered the most common causes in children. Request pdf malignant childhood proptosis children proptosis enrolled in ophthalmic tumor clinic at a tertiary cancer center from july 2003 to december 2006. A case report article pdf available in journal of clinical and diagnostic research 118. Prominent proptosis in childhood thyroid eye disease grant t. Unilateral proptosis archives of disease in childhood. Only 15% of acute myeloid leukemia is seen in children and only 9.
Proptosis in patients was significantly higher than in control group. Thus, a detailed history, clinical examination and ct scan were the most fruitful approach to the diagnosis of childhood proptosis in this series. Childhood proptosis is quite different from that of the adult. Wesselingperry k, salusky ib 2016 mineral and bone disorders in children with chronic kidney disease. Differential diagnosis of the swollen red eyelid robert. Proptosis and surgical approaches to the orbit in children.
Measurements of proptosis were done in children and teenagers with thyroid diseases. The records of children under 15 years of age presenting with proptosis to the childrens hospital, camperdown, sydney, were. The aim of the study was to assess visual acuity, refractive status, and eye proptosis in children and young adults with graves disease. The frequency of inflammatory lesions, particularly ethmoiditis progressing to proptosis, appeared to have decreased, probably because of the liberal use of antibiotics for upper respiratory. Proptosis in children age group is a difficult clinical challenge in diagnosis and management.
Proptosis in the same reference is defined as exophthalmos. Systemic steroids oral prednisolone 6080mgday tapered over 28 weeks intravenous methylprednisolone 0. Proptosis as a clinical manifestation of childhood acute promyelocytic leukemia is very rare. It is an uncommon presentation in children seen by. Orbital signs and symptoms occur in approximately one half of. Periorbital chloroma and proptosis in a twoyearold child with acute myelogenous leukemia. On clinical examination, there was bilateral proptosis, 5 mm greater on the left. Unilateral proptosis, pain, fever, decreased ocular motility, erythema, and edema of the eyelids infectious orbital cellulitis usually bacterial extended posterior to orbital septum meningitis cavernous sinus thrombosis staphylococci. Considerations in pediatric proptosis ophthalmology. Radiology study of these tumors is extremely essential for distinguish possible diagnosis, once it. Clinicians should be aware of the clinical manifestations of this condition, which can be subtle. Hyperthyroidism is a rare but potentially serious disorder in childhood with unique effects on growth and development. Prominent proptosis in childhood thyroid eye disease.
I if, after clinical examination, thedisease appears tobeintraorbitalthenskullx. Noninfectious causes of proptosis in children springerlink. In children proptosis occurs far more readily than in adults because. In this video, we are going to see about the various causes of proptosis.
While thyroid disorders are the most common causes of proptosis in adults, orbital cellulitis is the most common cause among children 2. Pdf extramedullary leukemia in children presenting with. In the case reported aboveit is difficult to pinpoint the exact nature of the proptosis in the first instance, but. Appropriate medical history, full examination, diagnostic imagingtesting, and sometimes tissue biopsy are essential for determining the correct diagnosis and establishing appropriate management plan. Eye pain in children american academy of pediatrics. The investigation of proptosis in paediatric practice. The difference between the right and left eyes was not significant. Childhood proptosis usually denotes serious problem and requires emergent intervention as it is commonly caused by malignant lesions or at least threatens the vision 2. Extramedullary leukemia in children presenting with proptosis. We report an unusual case of acute myelocytic leukaemia in 10yearold male child presenting with acute bilateral proptosis as its sole manifestation to an ent surgeon and also.
Proptosis and double vision in a child pediatric cancer. Digitalization of eye bulging measurements is important for accurate assessment of proptosis, to compare results of. Proptosis is defined as an abnormal protrusion of eyeballs due to a space occupying lesions in the orbit. In adults with thyroid eye disease, proptosis is the second most common finding and can be due to orbital fat or eom enlargement. Nova southeastern university school of osteopathic medicine, ft. We highlight the orbital manifestations of acute myeloid leukemia and the role of peripheral blood smear in the diagnosis of these cases. Proptosis can be confirmed with exophthalmometry, which measures the distance between the lateral angle of the bony orbit and the cornea.
A total of 12 patients who presented with proptosis and were subsequently diagnosed to have acute myeloid leukemia based on incision biopsy or peripheral blood smear were included in the study. Orbital tumors in children are very rare and can initially manifest with ocular proptosis. The proptosis completely resolved and vision improved to 66 in the right eye after four cycles of chemotherapy. Pdf esthesioneuroblastoma presenting with bilateral. Aetiology of childhood proptosis sindhu 1998 journal. Heher, md,45 james a katowitz, md,45 michael kazim, md golnaz moazami, md thomas moshang, md,47 james w.
Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma. The relative incidence of the different causes of proptosis in. Causes of proptosis in children are different from that in adults. Proptosis in a young child article pdf available in the indian journal of pediatrics 736. The first page of the pdf of this article appears above. External examination was notable for left periorbital swelling, proptosis, and moderate ptosis of the upper eyelid figure 1a. Crawford1952 found six cases of proptosis due to leukaemia in a survey of 1 children with proptosis. We have done investigations of visual acuity, refraction, and eye proptosis in 16 children, 14 teenagers, and 49 adults with graves disease at eye clinic of lithuanian university of. Periorbital chloroma and proptosis in a twoyearold child.
Primary care physicians are often the first to see a child with the complaint of eye pain. Estimating proptosis by digitalized exophthalmometry in. Seventeen 63% of them had local or disseminated malignancy, a higher proportion than in earlier reports. Proptosis eye disorders msd manual professional edition. Complications after the removal of tumors were also noted. Twentyseven children with unilateral proptosis were investigated over a period of 8 12 years. Another american author recently reported that a chloroma was present in only four of 1,000 children. Exophthalmos can be either bilateral as is often seen in graves disease or unilateral as is often seen in an orbital tumor. To retrospectively analyse causes of childhood proptosis and their investigations and treatment. The invaluable, though often overlooked peripheral blood smear. This chapter provides an overview of noninfectious causes of proptosis in children. The management of orbital disease in pediatric patients differs greatly from management in adults, because.
Althoughmanyinvestigative techniquesare available for the assessment ofunilateral proptosis, we consider that the following investigations are useful in leading to a rapid andaccurate diagnosis. Assessment of visual acuity, refraction changes, and. Request pdf malignant childhood proptosis children inchildren as in adults. The child completed the full course of chemotherapy and is doing well. Accessorymethods of diagnosis are briefly considered. Differential diagnosis of orbital tumors in children. Pediatric endocrine unit, massachusetts general hospital for children and harvard medical school, boston, ma. Igg4related orbital inflammation presenting as bilateral.
In contrast myelogenous leukaemia only very rarely gives rise to extra ocular muscle infiltration. We have done investigations of visual acuity, refraction, and eye proptosis in 16 children, 14 teenagers, and 49 adults with graves disease at eye clinic of lithuanian university of health sciences medical academy. Ophthalmology division, nicklaus childrens hospital, miami, fl. They estimated unilateral proptosis in 40% 3689 and bilateral proptosis in 60% reported extramedullary leukaemia in 12 children aged 117 years, mean age 8. Acute promyelocyte leukemia in a child presented with.
The measurement of normal values of exophthalmos, interpupillary distance and interorbital distance of children and adolescence in xiamen and the rule of their development. These lesions have different etiologies, which are divided into benign or malignant, and can be primary from orbital or be a metastatic product. Table 1 aetiology ofunilateral proptosis in children local causes. Leukaemia should be included in the differential diagnosis of proptosis in children. This is a concise presentation for medical students especially from india. Hyperthyroidism in children american academy of pediatrics. Exophthalmos is defined in dorlands medical dictionary as an abnormal protrusion of the eyeball. Similarly, biswas et al studied the uncommon clinical features in childhood leukemia and reported only two cases presenting as proptosis in a study involving 75 patients and both were. Edema and inflammation of ocular muscles subacute onset bilateral proptosis, possible. Methods of investigations, orbital imaging and diagnosis will be discussed.
Ten years earlier, she had been diagnosed as having ophthalmic graves disease and subsequently underwent successful left transantral orbital decompression for optic nerve compression. Recurrent proptosis and thyroid eye disease postgraduate. Extraocular motility examination results were normal in the right eye but demonstrated severe ophthalmoparesis of the left eye. Acute lymphoblastic leukemia all, a common hematological malignancy observed in children, typically presents with fever. Eyes that bulge, or protrude out of their normal position, could be a sign of a serious medical condition.
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