The most common cause of both unilateral & bilateral PROPTOSIS is Graves' disease. PROPTOSIS is an important sign in the severity of ophthalmopathy in Graves' disease. To determine the prevalence of PROPTOSIS in Graves' disease and its risk factors, 238 patients were evaluated by exophthalmometery. The prevalence of PROPTOSIS in the new cases and old ones were 19.8 and 19.1 per cent, respectively (p>0.05). No relationship with smoking and sex and serum thyroid hormone levels could be found, however, there was significant correlation between hypothyroidism and ablation with radioiodine. There was an inverse relationship with PROPTOSIS and age in females (r = -0.24; p<0.000l). Prospective, controlled studies should be conducted to reveal the risk factors for PROPTOSIS in Graves' disease.

Case Question: A five-year-old boy developed PROPTOSIS of the left eye (Figure 1) for which he was referred to an ophthalmologist. An orbital CT scan was performed (Figures 2 and 3). What is your differential diagnosis?

Congenital orbital wall defects are very rare bone abnormalities that can cause protrusion of intracranial contents into the orbit. The protrusion of the meninges, which encompasses cerebrospinal fluid (CSF), result in a condition known as the orbital meningocele, a rare cause of pulsatile PROPTOSIS. Here, we present a 4-year-old female with left eye PROPTOSIS referred to our clinic. On magnetic resonance imaging (MRI), a cystic structure was present. The patient underwent surgery for cyst removal. CSF leakage was noted during surgery. Computed tomography (CT) scan revealed a bony defect in the sphenoid greater wing and the resulting meningocele. Craniotomy surgery was performed to close and fill the defect.

Purpose: Acute lymphoblastic leukemia (ALL), a common hematological malignancy observed in children, typically presents with fever, pallor, easy bruising, hepatosplenomegaly and lymphadenopathy. However, when ALL manifests with unusual signs and the blood counts and peripheral smears are normal, it causes a diagnostic dilemma. Case Report: We report a 5‑ year‑ old boy who presented with bilateral PROPTOSIS as the initial manifestation of ALL. He presented with fever and bilateral knee pain attributed to a fall while playing. There was a history of progressive bilateral PROPTOSIS for a 3‑ month period not associated with any other complaints such as fever, eye pain, redness, or tearing. Thyroid function tests were normal. Blood counts acquired upon PROPTOSIS presentation were normal. When he presented to us three months later, blood counts revealed a pancytopenia but the peripheral smear showed no abnormal cells. Magnetic resonance imaging of the brain and orbits was normal. Bone marrow aspirate flow cytometry confirmed the diagnosis of B cell acute lymphoblastic lymphoma. Conclusion: Ophthalmologists should be aware of the unusual ophthalmologic manifestations of acute leukemia, as they may precede overt leukemia and cause diagnostic dilemmas. Knowledge about the rare and isolated extramedullary manifestations of ALL facilitates early diagnosis and thereby improves prognosis.

Simultaneous PROPTOSIS and facial palsy as the clinical presentation of childhood Acute Myeloid Leukaemia (AML) is very rare. To date, no case have been reported anywhere to the best of our knowledge. Extra medullary leukemic deposits or Granulocytic Sarcoma (GS) is a rare manifestation in about 3% of childhood AML, 9.3% of GS manifested as orbit deposits causing PROPTOSIS in one or both eyes. CNS infiltration or acute otomastoiditis subsequent to leukemic infiltration of the temporal bone may be implicated with facial paralysis. We are here with reporting the case in a 3-year-old boy who presented with PROPTOSIS and facial palsy in a case of AML. The purpose of reporting this case is to emphasize the need of examining the peripheral blood and bone marrow in children presenting as PROPTOSIS and facial palsy for early diagnosis of childhood AML.

Introduction: Exophthalmia is defined as an abnormal protrusion of the eyeball; also labeled as PROPTOSIS. PROPTOSIS, due to any cause, can compromise visual function and the integrity of the eye structure. The aim of this study was to evaluate etiological factors, clinical findings, imaging studies, histopathological, and prognostication in patients with exophthalmia. Material and Methods: This descriptive study was done from 1995 to 2005 in Neurosurgery Department of Gham Hospital of Mashhad. 50 cases with documented medical history, clinical examination, and pathology reports were studied. Data was gathered in a questionnaire and analyzed with descriptive statistics and chiary-square test.Results: There were 28 male (56%) and 22 female (44%) patients. Mean age was 32.9 years (with range of 10months to 70 years); Mean age of female patients was 36.8 years and in male ones it was 27.8 years. Right eye was involved in 48% of patients and left eye in 52%. The most common cause of PROPTOSIS was meningioma with orbital involvement (12%), in 10% of cases it was located in the .lesser wing of sphenoid and in 2% in the optic nerve sheath. Other common causes of PROPTOSIS were frontal bone osteoma with extension to orbit (8%), fibrous dysplasia (8%), orbital pseudo tumor (6%), sinus mucocele (6%), orbital cavernous hemangioma (6%), dermoid and epidermoid cysts of the orbit (6%), hydatid cyst (6%), carotid- cavernous Fistula (6%), and optic never glioma (4%). In 25%, PROPTOSIS was associated with decreased vision.Conclusion: The most common cause of PROPTOSIS in neurosurgery ward was meningioma; mostly lesser wing sphenoid meningioma, which in most cases was associated with decreased vision.

Purpose: To report a case of orbital oculomotor nerve schwannoma extending to the cavernous sinus through the superior orbital fissure presenting with PROPTOSIS, but without any neurological sign.Case Report: A 32-year-old man presented with axial PROPTOSIS of his left eye. Visual acuity and other ocular examinations were normal. Orbital magnetic resonance imaging revealed a well‑defined fusiform retrobulbar lesion in the left orbit extending into the superior orbital fissure and left cavernous sinus measuring 43 mm×21 mm×19 mm and causing superomedial displacement of the optic nerve and axial PROPTOSIS. The patient was scheduled for surgery, and gross total excision was done. Postoperatively, the patient developed total third nerve palsy. Pre and postoperative third nerve deficit confirmed the origin of the tumor from the oculomotor nerve. Histopathological examination revealed schwannoma.Conclusion: Orbital oculomotor nerve schwannoma, although rare, can be the cause of PROPTOSIS. Diagnosis can be confirmed histopathologically. It is a benign tumor; however, it can extend intracranially without any neurological symptoms. Therefore, neuroimaging is essential to rule out intracranial extension. Early surgical removal is mandatory.

Introduction: intracranial meningiomas, with extension into the orbit through bone, the superior orbital fissure, or the optic canal, and optic nerve sheath meningiomas can lead to PROPTOSIS and visual loss. In this study we evaluated meningiomas’s cases presented with PROPTOSIS in Ghaem Hospital from 1374 to 1384 with respect to etiological factors, clinical findings, imaging studies, histopathological and prognostication.Materials and Methods: we reviewed medical records of fifty patients that because of orbital mass and PROPTOSIS underwent cranio-orbital surgery, then cases of meningiomas (a with respect to pathology) selected. The chi-square test was used for the statistical analysis. Results: Of fifty cases with PROPTOSIS, 6 cases (12%) were meningiomas with orbital involvement. In 6 meningioma’s cases, 5 (83%) were intracranial sphenoid wing meningiomas with orbital extension and 1 (17%) was optic nerve sheath meningiomas. Of six patients with meningiomas’s diagnosis, there were women (67%) and men. Mean age of patients in secondary meningiomas was 54.4 years (43-70 years) and in one primary meningiomas age was 21 years. In all cases there was decreased vision in addition to PROPTOSIS.Conclusion: The most common orbital meningiomas were secondary that arise intracranial. Visual loss is frequent; the most common cause of PROPTOSIS in neurosurgery ward is sphenoid wing meningiomas.

Acute lymphocytic leukemia (ALL) is one of the frequent malignancies in pediatrics and involves bone marrow and extramedullary sites. PROPTOSIS as extramedullary involvement of leukemia usually present in acute and chronic myeloid leukemia. It is extremely rare for ALL to present initially as PROPTOSIS. Here, a-21-month-old boy was presented with PROPTOSIS without any associated symptoms except lymphadenopathy. He was referred with the impression of malignancy from an ophthalmologist. After bone marrow biopsy which showed 33% blast cells, all positive for CD10, CD19, and CD79, the diagnosis of pre-B cell ALL was finally made. His symptoms were improved completely 16 days after starting standard protocol for ALL. Afterone-year follow-up, he was free of any symptoms. According to this initial presentation of ALL and no typical associated symptoms, it is important to make rapid diagnosis and start the treatment in the childhood.