Proptosis - Differential Diagnosis - Unilateral vs Bilateral

Unilateral:

 • Infections (can become bilateral with cavernous sinus thrombosis)

     - Orbital cellulitis

     - Mucormycosis

     - Aspergillosis

 • Vascular

     - Orbital hemangioma

     - Orbital hemorrhage

 • Inflammatory

     - Paranasal sinus mucoceles

     - Inflammatory pseudotumor (IgG4 disease)

     - Sarcoid (can be bilateral)

 • Neoplasms

     - Metastatic (breast, prostate, lung)

     - Lacrimal Gland Tvumor

     - Orbital lymphoma

     - Orbital rhabdomyosarcoma

     - Spheno-orbital meningiomas

     - Langerhans's cell histocytosis

Bilateral:

 • Infections (with cavernous sinus thrombosis)

 • Inflammatory

     - Grave's disease (rarely unilaterally)

     - Orbital myositis

 • Neoplasm

     - Metastatic neuroblastoma

 • Vascular

     - Cavernous sinus thrombosis

     - Carotid cavernous fistula



Red Flags:

 • Diplopia

 • Fevers

 • Eye pain

 • Eye redness

 • Ophthalmoplegia

 • HeadacIae



Dr. Ann Marie Kumfer @AnnKumfer



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