Proptosis in pediatrics

PROPTOSIS IN PEDIATRIC PATIENTS

prospective study by DR VIJAYLAXMI SHRIVASTAVA DR G. MALINI

JAWAHARLAL NEHRU HOSPITAL & RESEARCH CENTRE STEEL PLANT HOSPITAL

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

INTRODUCTION

PERMANENT SEQUELAE

• CORNEAL ULCERATION• CORNEAL OPACITY• OPTIC ATROPHY• BLINDNESS

INTRODUCTION

PROPTOSIS

OPTHALMOLOGISTOTOLARYNGOLOGIST

RADIOLOGIST

PATHOLOGIST NEUROSURGEON

CLINICIANPROPTOSIS

ONCOLOGIST

AIMS & OBJECTIVES

TO ANALYSE• INCIDENCE• ETIOLOGICAL FACTORS• CORRELATION WITH

INVESTIGATIONAL MODALTIES• MANAGEMENT & OUTCOME

OF CHILDHOOD PROPTOSIS

MATERIALS & METHODS

• PROSPECTIVE STUDY• DURATION:THE CALENDER YEAR 2007.• CASES WITH PROPTOSIS ADMITTED IN THE

PEDIATRICS WARD DURING ABOVE PERIOD

MATERIALS & METHODS

• HISTORY• EXAMINATION• INVESTIGATION• MANAGEMENT• FOLLOW UP

OBSERVATIONS

0

1

2

NU

MB

ER

6 MONTHS 4 YEAR 8 YEAR 9 YEAR 13 YEAR

AGE DISTRIBUTION

MOST CASES WERE TODDLERS - 4/7

• TOTAL n= 7 • MALE 5/7

SEX DISTRIBUTION

2

5

FEMALE

MALE

OBSERVATIONS CONTD

• TOTAL n=7

2

5

BILATERALUNILATERAL

OBSERVATIONS CONTD:

PRESENTING COMPLAINTS

5 53 2

01234567

HEADACHE PAIN FEVER VOMITING

DURATION OF COMPLAINTS

1512

108

7

52

0123456789

101112131415

DAYS

PREDISPOSING FACTOR

SINUSITIS-ETHMOIDAL, SPHENOIDAL, & MAXILLARY

3

FURUNCULOSIS OF NOSE 1UPPER RESPIRATORY TRACT INFECTION

1

DENTAL CARIES 1

CONJUCTIVITIS 1

SIGNS

LID EDEMA CHEMOSIS MENINGEALSIGNS

6 N PALSY 4 N PALSY 3 N PALSY CONVULSION

7

4 4

3 3

2

1

0

1

2

3

4

5

6

7

PUPILLARY REACTION

34

NORMAL

DILATED & SLUGGISH REACTION TO LIGHT

4/7

FUNDUS EXAMINATION

4

3

NORMAL PAPILLEDEMA

3/7

INVESTIGATIONS

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

INVESTIGATIONS

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

ETIOLOGY

33

1

3

0

1

2

3

4

5ORBITAL CELLULITIS WITHSINUSITIS WITH CAVERNOUS SINUSTHROMBOSISORBITAL CELLULITIS

RHABDOMYOSARCOMA

PROTHROMBOTIC DISORDER

CAVERNOUS SINUS THROMBOSIS

ORBITAL CELLULITIS

ORBITAL CELLULITIS

RHABDOMYOSARCOMA

MANAGEMENT

• CONSERVATIVE• SURGICAL INTERVENTION• CHEMOTHERAPY

CONSERVATIVE MANAGEMENT

• MANAGEMENT OF SHOCK• AGGRESSIVE ANTIBIOTIC COVERAGE • TOPICAL ANTIBIOTICS & EYE CARE• LMWH(ENOXAPARIN)- IN 1 CASE OF

CAVERNOUS SINUS THROMBOSIS• SUPPORTIVE THERAPY

ONCOLOGICL MANAGEMENT

CHEMOTHERAPY

VAC - VINCRISTINE

-ACTINOMYCIN

- CYCLOPHOSPHAMIDE

SURGICAL MANAGEMENT

• INCISION & DRAINAGE OF ABSCESS• CRANIOTOMY & EVACUATION OF PUS• SINUS DRAINAGE • EXTRACTION OF CARIES TEETH

COMPLICATIONS

COMPLICATIONS RATE OTHER STUDIES

OUR STUDY

VISUAL IMPAIRMENT 10-30% 14%

CAVERNOUS SINUS THROMBOSIS

40% 42%

NEUROLOGICAL DEFICIT

50% 14%

NO COMPLICATIONS ON FOLLOW UP

CRANIAL NERVE PALSY WITH VISUAL IMPAIRMENT

DISCUSSION

STUDY COMPARISON DATA

MALE :FEMALE RATIO

2.5:1 AGRAWAL etal(1979)

1.9%

BELMEKKI (1999)

2%

NAGESWARAN etal(2006)

2.7%.

SEEMA etal (2006) 1.6%

DISCUSSION


AGE LESS THAN 5 YEARS

57% AGRAWAL etal(1979)

60%

UNILATERAL

71% MERCHANT etal (1993)

68%

DISCUSSION

RISK STUDY COMPARISON DATA

SINUSITIS 42% RODRIQUEZ etal(2000)

68%

LID & FACE INFECTION

28 % RODRIQUEZ etal(2000)

28 %

DISCUSSION


INFLAMMATORY ETIOLOGY

71% SINDHU etal(1998) 39%

MAJEKODUNMI etal(NIGERIA 1982)

52%.

DISCUSSION


BLOOD CULTURE

14% SEAN etal (1998) 10%

GOMEZ etal(1996).

23%

DISCUSSION


SURGERY 57% NAGESWARAN etal (2006).

71%

CONCLUSION

• NOT UNCOMMON• INFLAMMATION FROM ADJACENT SITE• CAVERNOUS SINUS THROMBOSIS

FREQUENT

HIGH MORTALITY

CONCLUSION

• PERMANENT DEFICIT• PROTHROMBOTIC STATES COEXISTS

CONCLUSION

EARLY & PROMPT THERAPY LEADS TO COMPLETE RECOVERY & SATISFYING OUTCOME

Education

Proptosis in pediatrics