Valores normativos de exoftalmometría en individuos hispanos / Normative exophthalmometry values in Hispanic individuals

Propósito Se han establecido valores normativos de exoftalmometría en individuos caucásicos, asiáticos y negros. Aunque estudios anteriores han examinado las medidas perioculares en diferentes grupos raciales y étnicos, este estudio es el primero en establecer valores normativos de exoftalmometría en una población hispana de la ciudad de Nueva York. Métodos Este estudio de corte transversal fue aprobado por el IRB y cumple con HIPAA. Se incluyeron pacientes adultos hispanos. El grado de prominencia ocular (valor de exoftalmometría, VE) y la distancia interorbitaria (base de Hertel, DIO) se obtuvo mediante el uso del exoftalmómetro de Hertel. Las diferencias en VE entre sexos se evaluaron utilizando la prueba t para dos muestras. Se utilizó modelo de regresión lineal múltiple para determinar el efecto de la edad, el sexo y el índice de masa corporal (IMC) en el VE. Resultados De los 277 individuos hispanos incluidos, 189 (68,2%) fueron mujeres y la edad media fue de 63,0 años (DE=15,0). La media de la base de Hertel y del VE para todos los participantes fue de 92,0mm (DE=4,1) y 16,7mm (DE=2,4), respectivamente. Los valores medios de exoftalmometría de los hombres fueron significativamente más altos que los de las mujeres (17,6mm y 16,2mm, respectivamente, p≤0,001). Los VE más altos se asociaron positivamente con el sexo masculino (ß=−1,60, p<0,0001) y el IMC (ß=0,084, p=0,001), pero no con la edad. Conclusiones El VE en individuos hispanos es de 16,7mm, el cual es mayor que el reportado para la mayoría de los caucásicos y asiáticos, pero menor que el de los individuos negros. Un VE más alto se asocia significativamente con el sexo masculino y un mayor IMC. Este estudio es el primero en crear los valores normativos de exoftalmometría en una población hispana y que puede ser utilizado como herramienta de referencia para en el diagnóstico y control de enfermedades orbitarias (AU)

Purpose Normative exophthalmometry values have been established in Caucasians, Asians, and Black individuals. While prior studies have examined periocular measurements in different racial and ethnic groups, this study is the first to establish a set of normative exophthalmometry values in a Hispanic population in New York City. Methods This prospective, cross-sectional cohort study was IRB approved and HIPAA compliant. Adult patients self-identifying as Hispanic were included. The degree of ocular prominence (exophthalmometry value, EV) and the inter-orbital distance (Hertel's base, IOD) was obtained by Hertel exophthalmometry. Differences in EV between sexes were evaluated using two sample t-tests. Multivariable linear regression was utilized to determine the effect of age, sex, and body mass index (BMI) on EV. Results Of the 277 Hispanic individuals included, 189 (68.2%) were female and the mean age was 63.0 years (SD=15.0). The mean Hertel's base and mean EV for all participants was 92.0mm (SD=4.1) and 16.7mm (SD=2.4), respectively. Average exophthalmometry values for men were significantly higher than women's (17.6mm and 16.2mm, respectively, p≤0.001). Higher EVs were positively associated with male gender (ß=−1.60, p<0.0001) and BMI (ß=0.084, p=0.001), but not age. Conclusions The mean EV in Hispanic individuals is 16.7mm, higher than that reported for most Caucasians and Asians, but less than that of Black individuals. Higher EV is significantly associated with male sex and increased BMI. This study is the first to create a set of normative exophthalmometry values in a Hispanic population, which may serve as a valuable tool for clinicians to reference when diagnosing and monitoring orbital disease (AU)

Hertel Exophthalmometry Values in a Greek Adult Outpatient Clinic-Based Population: Association With Demographic Factors and Systemic Disease.

PURPOSE: To investigate correlations of exophthalmometry values (EVs) with age, gender, and the presence of diabetes mellitus, arterial hypertension, and dyslipidemia. METHODS: In a cross-sectional, clinic-based study, consecutive adult Greek patients presenting for evaluation at the outpatient general clinic on a scheduled appointment basis at a tertiary care referral center were submitted to Hertel exophthalmometry in both eyes by the same observer. Subjects with signs of history or orbital pathology, including thyroid-associated ophthalmopathy, were excluded. Demographics, as well as a detailed systemic history report, were recorded. Mixed effect linear regression analysis was performed to account for the correlation between the eyes of the same participant. RESULTS: A total of 800 eyes (400 subjects) were included, 194 males and 206 females, with a mean age of 67.82 ± 12 years (range: 18-92 years). The mean exophthalmometry value was 15.7 ± 2.6 mm (range: 11-21 mm). Every one year of increase in age is associated with a decrease in EVs by 0.03 mm (95% CI -0.04, -0.02/p-value<0.001). Female gender was associated with lower EVs by 0.33mm (95% CI-0.56, -0.1/p-value=0.005). Patients with diabetes mellitus had higher EVs by 0.47 mm (95% CI 0.25, 0.70/p-value<0.001) compared to patients without diabetes, and patients with arterial hypertension had lower EVs by 0.26 mm (95% CI -0.5, -0.02/p-value=0.034) compared to patients without hypertension. No association was found between dyslipidemia and systemic history of thyroid dysfunction.  Conclusions: A negative correlation of EVs was noted with increasing age, female gender, as well as history of arterial hypertension and a positive correlation with diabetes mellitus.

Normative exophthalmometry values in Hispanic individuals.

PURPOSE: Normative exophthalmometry values have been established in Caucasians, Asians, and Black individuals. While prior studies have examined periocular measurements in different racial and ethnic groups, this study is the first to establish a set of normative exophthalmometry values in a Hispanic population in New York City. METHODS: This prospective, cross-sectional cohort study was IRB approved and HIPAA compliant. Adult patients self-identifying as Hispanic were included. The degree of ocular prominence (exophthalmometry value, EV) and the inter-orbital distance (Hertel's base, IOD) was obtained by Hertel exophthalmometry. Differences in EV between sexes were evaluated using two sample t-tests. Multivariable linear regression was utilized to determine the effect of age, sex, and body mass index (BMI) on EV. RESULTS: Of the 277 Hispanic individuals included, 189 (68.2%) were female and the mean age was 63.0 years (SD = 15.0). The mean Hertel's base and mean EV for all participants was 92.0 mm (SD = 4.1) and 16.7 mm (SD = 2.4), respectively. Average exophthalmometry values for men were significantly higher than women's (17.6 mm and 16.2 mm, respectively, p ≤ 0.001). Higher EVs were positively associated with male gender (ß = -1.60, p < 0.0001) and BMI (ß = 0.084, p = 0.001), but not age. CONCLUSIONS: The mean EV in Hispanic individuals is 16.7 mm, higher than that reported for most Caucasians and Asians, but less than that of Black individuals. Higher EV is significantly associated with male sex and increased BMI. This study is the first to create a set of normative exophthalmometry values in a Hispanic population, which may serve as a valuable tool for clinicians to reference when diagnosing and monitoring orbital disease.

The Role of Thermal Camera in the Assessment of Thyroid Eye Disease Activity.

Background: Thyroid eye disease (TED; also known as thyroid - associated orbitopathy, Graves ophthalmopathy) is an autoimmune inflammatory disease which presents in typical signs and symptoms such as deep orbital pain, chemosis with or without caruncular edema, unilateral or bilateral proptosis, eyelid retraction, eyelid edema or erythema, restrictive strabismus and compressive optic neuropathy. Objective: The aim of this study was to investigate the role of thermal camera in the assessment of thyroid eye disease (TED) activity compared to the Clinical Activity Score (CAS) scale, exophthalmometry values, and thyroid hormone and antibody levels. Methods: A total of 50 patients participated in this cross-sectional study of whom 29 were in the active phase of TED according to the sum on CAS scale and 21 patients in the inactive phase. The Flir E8® thermal camera was used to measure the temperature of the orbital area and the values were compared with the CAS scale, exophthalmometry values and thyroid hormone and antibody levels. Results: Higher values of temperature (p>0.0001), CAS score (p>0.0001), exophthalmometry (p=0.022), FT4 (p=0.0176) and TRAb (p=0.0091) were found in patients in the active phase of TED. Temperature of orbital area showed statistically significant positive correlation with CAS scale (p=0.0001), exophthalmometry values (p=0.0022) and anti-TPO levels (p=0.019). Conclusion: Thermal camera showed higher values of the temperature of the orbital area in patients in the active phase of the disease and positively correlated with the CAS scale, exophthalmometry findings and anti-TPO levels.

Validation of exophthalmos magnetic resonance imaging measurements in patients with Graves' orbitopathy, compared to ophthalmometry results.

Purpose: Although assessment of the orbital structures using magnetic resonance imaging (MRI) is well described in the literature, there is no consensus as to which measurement method is the most useful in exophthalmos assessment. The aim of the study was to correlate 2 MRI methods of exophthalmos measurement with exophthalmometry results and to determine a proper technique of exophthalmos measurement. Material and methods: Fifty-four patients (108 orbits) with exophthalmos in the course of Graves' orbitopathy were enrolled in the study. Two measurements on axial T2W orbital MRI images were performed by 2 independent radiologists: the distance from the interzygomatic line to the anterior surface of the globe (AD) and the distance from the interzygomatic line to the posterior sclera (PD). Within 4 weeks, an exophthalmometry was performed by an ophthalmologist using a Hertel exophthalmometer. The inter-observer variation was assessed using the Pearson correlation coefficient. Values were presented as mean and standard deviation, and the differences in values were explored with Student's t-test. Results: The mean AD measured on MRI by the first observer was 20.6 ± 3 mm, and 20.6 ± 2.9 mm by the second observer. PD values were 2.9 ± 2.8 mm and 3.4 ± 2.8 mm, respectively. The mean exophthalmometry result was 21 ± 3.3 mm. The correlation was very high between observers for AD measurements (r = 0.98, p = 0.01) and high for PD measurements (r = 0.95, p = 0.01). AD measurements on MRI and exophthalmometry results were strongly correlated (r = 0.9, p = 0.01). Conclusions: The AD measurement has better reproducibility and is directly correlated with Hertel exophthalmometry. This method could be sufficient in routine practice.

Determination of exophthalmometry values in the North Indian population.

Purpose: To determine exophthalmometry values (EV) in the north Indian population and to find its correlation with the age, gender, height, weight, body mass index (BMI), locality, and base value of the population. Methods: A total of 1000 eligible participants with 504 females and 496 males with age >5 years were included in this observational cross-sectional study. Age, gender, and locality of the subjects were noted. Hertel's exophthalmometry was performed on all subjects. The exophthalmometry values and base values were recorded. Height and weight were measured for all participants. BMI was calculated using the parameters. Results: The overall mean exophthalmometry value (mm) was 14.94 ± 2.43 mm with a range between 8 and 22 mm. There was no significant difference in EV between the two eyes. Males recorded a significantly higher mean EV of 15.4 ± 2.51 mm as compared to females with a value of 14.49 ± 2.27 mm. Base value of Hertel's exophthalmometer had a mean value 100.78 ± 5.63 mm and a range of 84-120 mm. Age, height, weight, BMI, and locality of the subjects were found to have a significant effect on the exophthalmometry as well as the base value of the population. A significant correlation was also seen between exophthalmometry values and base values of the population. Conclusion: Our study provided the normal exophthalmometric range for the north Indian population and also demonstrated the relationship of age, gender, height, weight, BMI, locality, and base value with the exophthalmometric values.

Utilizing a mobile platform to obtain quantitative measurements of exophthalmos.

PURPOSE: This study introduces a novel exophthalmometry method utilizing a mobile platform to obtain calibrated quantitative measurements of globe position and compares its reliability to Hertel exophthalmometry. METHODS: A prospective, comparative study included 50 patients (99 eyes) for a total of 594 mobile measurements. Healthy individuals from the community in Augusta, Georgia, and individuals from a routine oculoplastics clinic at Mayo Clinic in Rochester, Minnesota, were included to represent variety within the population. The main outcome was the inter-modality correlation and agreement between Hertel and mobile exophthalmometry, and the intra-observer and inter-observer reliability with repeated mobile measurements. RESULTS: There was no significant difference in the measurements obtained by Hertel exophthalmometry and mobile exophthalmometry. There was a strong linear correlation between Hertel and mobile exophthalmometry with a Pearson Correlation Coefficient of 0.910 and 0.888 for the right and left eyes, respectively (p < .001, 2-tailed). Bland-Altman plot analysis showed excellent agreement between the two modalities. The mobile platform demonstrated high intra-observer reliability with a Cronbach's alpha of 0.992 and 0.985 for the right and left eyes. An intraclass correlation coefficient of 0.992 (95% CI: 0.987-0.995) for the right eye and 0.986 (95% CI: 0.978-0.991) for the left eye demonstrated excellent reliability between observers. CONCLUSIONS: Mobile exophthalmometry may be a promising tool for obtaining calibrated quantitative measurements of globe position for situations in which Hertel exophthalmometry is not available. The strong correlation and excellent agreement between Hertel and mobile measurement suggest that mobile exophthalmometry can yield reliable and accurate measurements.

Validation of Modified Hertel Exophthalmometer.

STUDY DESIGN: This is a correlation study. OBJECTIVE: The objective was to obtain normative values from modified Hertel exophthalmometer, to compare difference in values between modified and standard Hertel exophthalmometer and to statistically analyze for correlation. METHODS: The study to validate the modification done to Hertel exophthalmometer was performed at the Department of Oral and Maxillofacial Surgery at our institute. Informed consent was obtained from patients; measurement in 100 volunteers was made with Hertel and modified Hertel exophthalmometer by a single observer, and the measurements taken by the 2 devices were tabulated along with variables such as age and gender. Data were collected and statistical analysis was performed to compare and correlate the values between standard and modified exophthalmometer. Differences of ocular protrusion values in gender and age were also calculated. RESULTS: There has been no statistically significant difference in the normative data between standard Hertel and modified Hertel exophthalmometer and in relation to age and gender. CONCLUSIONS: The modification of the Hertel exophthalmometer is validated and can also be used for relative exophthalmometry to assess the need for treatment and to evaluate the globe position and orbital volume intraoperatively. The proposed modification of the instrument allows it to be used in cases when one of the lateral orbital walls is fractured or displaced due to trauma.

Normal Exophthalmometry Values in Iranian Population: A Meta-analysis.

There are limited studies on the normal values of eye protrusion in Iran. Systematic efforts to provide acceptable normal exophthalmometry values for Iranian population are required for a proper approach to orbital diseases.English and Farsi language publications in PubMed, the ISI Web of Knowledge database, Iranian SID, and Iran Medex were searched using the following keywords: "proptosis", "eye protrusion", "exophthalmous", "Hertel exophthalmometer" and "Iran". Four articles from 1995 to 2010 were found and included in the meta-analysis. Statistical analysis was performed using the Metan command within Stata 15.0 software.It included 3,696 subjects in whom the average eye protrusion was 16.5 mm (95% CI: 15.1-17.8) in men and 16.2 mm (95% CI: 14.6-17.7) in women (P = 0.5). Mean left and right eye protrusion were 16.3 (95% CI: 14.7-18.1) and 16.4 mm (95% CI: 14.8-17.7), (P = 0.3), respectively. While Iranian teenagers (13-19 years old) showed a mean value of 17.1 mm (95% CI: 15.0-19.1), older age group ( ≥ 20 years) showed a lower mean eye protrusion of 16.3 mm (95% CI: 14.8-17.7). Considering the two standard deviations, the highest normal value of eye protrusion in Iranian population is 20.1 mm.In conclusion,Iranian normal eye protrusion values were higher than Asians and lower than Caucasians.

Uso terapéutico de la hialuronidasa y la triamcinolona en el pseudotumor orbitario / Therapeutic use of hyaluronidase and triamcinolone in orbital pseudotumor

RESUMEN El origen del pseudotumor orbitario no es del todo conocido. Se admite su naturaleza inflamatoria granulomatosa e inespecífica en diferentes localizaciones. El pseudotumor orbitario se define como una respuesta inflamatoria celular pleomórfica, que está usualmente confinado a estructuras de la órbita y tiene una evolución limitada. En este trabajo se presenta una paciente femenina de 16 años, con diagnóstico de pseudotumor orbitario corroborado por biopsia y tomografía axial computarizada, refractaria al tratamiento con esteroides sistémicos, por lo que se decide iniciar con la aplicación de hialuronidasa y triamcinolona en el espacio peribulbar. Los casos agudos casi siempre responden rápidamente al tratamiento con cortocoesteroides, como prednisona, pero debemos tener en cuenta que existen pacientes que son refractarios al tratamiento, por lo que es necesario buscar procedimientos alternativos. Una opción es el uso de hialuronidasa para destruir las uniones extracelulares, y difundir un esteroide de manera local, como la triamcinolona, más efectiva dentro del tejido inflamatorio para provocar un efecto localizado de este. A los tres meses del tratamiento hubo una regresión total del cuadro en esta paciente(AU)

ABSTRACT The exact etiology of orbital pseudotumor is unknown, but its granulomatous unspecific inflammatory nature at various locations has been recognized. Orbital pseudotumor is defined as a cellular pleomorphic inflammatory response of limited evolution often confined to orbital structures. A case is presented of a female 16-year-old patient diagnosed with orbital pseudotumor confirmed by biopsy and computerized axial tomography, refractory to treatment with systemic steroids, due to which it is decided to start treatment with hyaluronidase and triamcinolone in the peribulbar space. Acute cases often respond fast to treatment with corticosteroids such as prednisone. It should be borne in mind that there are patients who are refractory to treatment for whom alternative treatments should be sought. An option is the use of hyaluronidase to destroy extracellular junctions and locally spread a steroid such as triamcinolone, most effectively within the inflammatory tissue to ensure its localized effect. Total regression of the patient's status was observed at three months of treatment(AU)

A Comparison of Lower Eyelid Retraction in Normal Individuals with Positive versus Negative Orbital Vector.

PURPOSE: The present study aimed to compare lower eyelid retraction (LER) in individuals with a positive orbital vector with that of individuals with a negative orbital vector. MATERIALS AND METHODS: This cross-sectional study was conducted on 123 normal individuals including 64 men and 59 women aged 20-80 years. After the individuals underwent Hertel exophthalmometry, two side-view and front-view photos were taken using a camera. The orbital vector angle and the extent of scleral show were then measured in millimeter, using the Photoshop software. Eventually, the recorded data were analyzed through statistical software. RESULTS: The findings of this study showed that LER has a significant correlation with orbital vector angle and the extent of proptosis (P < 0.05). The mean value of orbital vector angle in individuals without LER was 9.76°, while this figure was calculated to be - 13.65° in individuals with LER. The mean protrusion value based on Hertel exophthalmometry was 14.08 mm in individuals without LER and 16.27 mm in individuals with LER. The extent of scleral show had a significant correlation with proptosis and orbital vector angle (P = 0.01), with a mean value of - 0.41 mm in individuals without LER and 0.94 mm in participants with LER. CONCLUSIONS: The prevalence of LER and scleral show is positively correlated with the extent of proptosis and negatively correlated with orbital vector angle.

Three-dimensional characterisation of the globe position in the orbit.

PURPOSE: Current methods to analyse the globe position, including Hertel exophthalmometry and computed tomography (CT), are limited to the axial plane and require the lateral orbital rim and cornea as landmarks. This pilot study aimed to design a method to measure the position of the globe in the axial, coronal and sagittal plane and independent from orbital bony and corneal references. METHODS: With the aid of three-dimensional CT reconstruction technology, we determined the globe position in the orbit based on the centre of the globe. Method validation was performed using data of consecutive orbital CT scans from the control group and from the patients with Graves' orbitopathy who underwent orbital decompression surgery with removal of the lateral orbital margin. RESULTS: The inter- and intra-observer reliability was excellent with a high intraclass correlation coefficient (> 0.99, 95% CI [0.97; 1.00]). In the decompressed orbits, there was a statistically significant globe position shift along the anterior-posterior axis (P = 0.0005, 95% CI [0.63; 3.66]), but not along the medial-lateral and superior-inferior axis. CONCLUSION: The 3D CT method can accurately and reliably characterise the globe position shift in the three dimensions without using orbital and corneal anatomical landmarks. The method can be useful to determine the globe shift in proptosis, enophthalmos, hypoglobus and hyperglobus, even in the presence of strabismus and orbital bone defects.

Analysis of contemporary tools for the measurement of enophthalmos: a PRISMA-driven systematic review.

Enophthalmos has many causes, and serious post-traumatic cases indicate the need for operation. Such diagnoses should be made objectively, and a robust method for quantifying the degree to which the globe has been displaced is key. Current methods of measurement, however, have long been considered unreliable and inconsistent, in particular with regard to interobserver variability. The aim of this paper therefore was to review all these methods systematically, to analyse their reliability, and to compare them with others. The paper also includes a proposed protocol for the accurate and reliable measurement of protrusion of an eye, which aims to standardise the assessment of patients and to create a uniform approach that will enable the selection of those who are most likely to benefit from surgical treatment. Analysis of the data showed that computed tomographic (CT) exophthalmometry is the most reliable, followed by the Mourits' exophthalmometer, which performed better than the other clinical methods. In the acute phase of orbital blowout fractures, the measurement of herniated tissue through a fracture defect may give a good prediction of the degree of enophthalmos that is likely to occur without surgical correction. Measurement of the herniated volume and CT exophthalmometry should be the foundation for diagnosis and the planning of treatment. Three-dimensional imaging or Mourits' exophthalmometers (which are reliable non-radiological methods) could be used in a follow-up protocol.

Measurement of Intra-Orbital Structures in Normal Chinese Adults Based on a Three-Dimensional Coordinate System.

PURPOSE OF THE STUDY: This study was to establish a three-dimensional (3D) coordinate system and to study the normal dimensions of intra-orbital structures in Chinese adults. MATERIALS AND METHODS: One hundred and forty-five adult Chinese were selected from patients who had undergone cranio-facial computed tomography scans with diagnosis other than orbital or ocular abnormality. An orbital 3D coordinate system was built on the basis of the scans. Morphological variables of intra-orbital structures were measured in this coordinate system. Bilateral symmetry, sexual dimorphism, and correlations between variables were investigated. RESULTS: No evident laterality was found in bilateral intra-orbital structures. The distance from the center of the eyeball to the prechiasmatic groove, the length of the optic nerve, and the thickness of rectus extraocular muscles were larger in males than in females. No sex-related difference was observed in the anteroposterior diameter of the eyeball or the exophthalmometric value. The exophthalmometric value was found to be related to the anteroposterior diameter of the eyeball, whereas the y-coordinate of the center of the eyeball had no correlation with the anteroposterior diameter of the eyeball. The optic nerve length was closely correlated to the distance from the center of the eyeball to the prechiasmatic groove. CONCLUSIONS: The 3D coordinate system and measurement method established in this study can be applied to the standardization of orbital morphometry. The measurements obtained from normal Chinese adults may provide reference values for the morphology of intra-orbital structures.

Orbital Fractures.

Anatomic, rather than volumetric, reconstruction leads to improved outcomes in orbital reconstruction. Endoscopic visualization improves lighting and magnification of the surgical site and allows the entire operative team to understand and participate in the procedure. Mirror-image overlay display with navigation-guided surgery allows in situ fine adjustment of the implant contours to match the contralateral uninjured orbit. Precise exophthalmometry is important before, during, and after surgery to provide optimal surgical results.

"The influence of orbital vector on involutional entropion and ectropion".

PURPOSE: This study aimed to evaluate the effect of orbital vector and other biometric parameters (i.e. axial globe length, axial globe projection) on the development of involutional entropion or ectropion. METHODS: In this cross-sectional study, 167 eyes from 132 patients were included. Of these eyes, 128 had involutional entropion and 39 had involutional ectropion, all of lower lids. The axial globe projection was measured using Hertel exophthalmometry; axial globe length was assessed by A-mode ultrasound; and orbital vector was determined clinically. Patient-specific categorical variables and continuous variables were compared using the chi-square test and the two-sided t test, respectively. Correlations were derived using the Pearson correlation. RESULTS: The percentage of females was 59% and 33.3% in the entropion group and in the ectropion group, respectively. A significant association was found between the gender and type of eyelid malposition (p = 0.015). Exophthalmometry reading was greater in the ectropion group than in the entropion group (17.7 ± 2.5 versus 10.8 ± 3.7 mm, respectively; p < 0.001). There was no significant correlation between axial globe length and exophthalmometry reading. Positive orbital vectors were observed in 87.5% of eyelids with involutional entropion. Negative orbital vectors were observed in 92.3% of eyelids with involutional ectropion (p < 0.001). Patients with negative orbital vectors showed greater axial globe projection than patients with positive orbital vectors (18.0 ± 2.1 versus 10.6 ± 3.5 mm, respectively; p < 0.001). CONCLUSIONS: There is an association between orbital vector measurement and involutional entropion and ectropion. Measuring the orbital vector may help predict the development of these lid malpositions.

Computed Tomographic Analysis of the Sagittal Orbit-globe Relationship.

Identifying the normal relationship of the orbital rims to the globes is critical in planning surgical correction of craniofacial deformities affecting the orbit. This article illustrates a technical proof of principle and mathematical basis for a computed tomography-based measurement of the sagittal orbit-globe relationship. The technique does not require subject cooperation and is, therefore, optimal for pediatric craniofacial surgical treatment planning and outcome evaluation.

[Comparison of Measurement Methods of Exophthalmos and Its Forensic Significance].

OBJECTIVES: To compare the differences between Hertel exophthalmometry and CT on exophthalmos measurement, and explore its practical application value in forensic medicine. METHODS: Fifty-six normal individuals without eye injuries or diseases were selected as the control group. The absolute values of exophthalmos were measured in the standardized CT image workstation. The difference of binocular exophthalmos was compared in normal group. Forty-seven cases with unilateral orbital fracture were divided into injured eye group and normal eye group according to the presence of binocular orbital fractures. The differences of the absolute values of eophthalmos from the same eye and the relative values of eophthalmos between two eyes for same person measured by Hertel exophthalmometry and CT were analyzed. RESULTS: There was no statistical difference of exophthalmos between the normal eyes measured by CT method. In the normal eye group, the absolute value of exophthalmos measured by CT method was （16.66±5.41） mm, which was （16.16±4.45） mm when measured by the Hertel exophthalmometry method. There was no statistical difference between two groups （P>0.05）. In the injured eye group, there was statistical difference between the absolute values of exophthalmos measured by two measurement methods （ P<0.05）. There was no statistical difference of the relative values of exophthalmos between the injured eyes and the normal eyes by two measurement methods （P>0.05）. CONCLUSIONS: CT method has a good consistency with Hertel exophthalmometry, which can be applied into the practice of medicolegal expertise.

Comparison of Measurement Methods of Exophthalmos and Its Forensic Significance / 法医学杂志

Objective To compare the differences between Hertel exophthalmometry and CT on exophthalmos measurement,and explore its practical application value in forensic medicine.Methods Fifty-six normal individuals without eye injuries or diseases were selected as the control group.The absolute values of exophthalmos were measured in the standardized CT image workstation.The difference of binocular exophthalmos was compared in normal group.Forty-seven cases with unilateral orbital fracture were divided into injured eye group and normal eye group according to the presence of binocular orbital fractures.The differences of the absolute values of eophthalmos from the same eye and the relative values of eophthalmos between two eyes for same person measured by Hertel exophthalmometry and CT were analyzed.Results There was no statistical difference of exophthalmos between the normal eyes measured by CT method.In the normal eye group,the absolute value of exophthalmos measured by CT method was (16.66±5.41) rm,which was (16.16±4.45)mm when measured by the Hertel exophthalmometry method.There was no statistical difference between two groups (P＞0.05).In the injured eye group,there was statistical difference between the absolute values of exophthalmos measured by two measurement methods (P＜0.05).There was no statistical difference of the relative values of exophthalmos between the injured eyes and the normal eyes by two measurement methods (P＞0.05).Conclusion CT method has a good consistency with Hertel exophthalmometry,which can be applied into the practice of medicolegal expertise.

Correlation between Hertel exophthalmometric value and refraction in young Cameroonian adults aged 20 to 40 years.

PURPOSE: To study the relationship between exophthalmometric value (EV) and refractive error in Cameroonian young adults. PATIENTS AND METHODS: A prospective descriptive study was carried out in the ophthalmic unit of the Yaoundé Central Hospital from March to May 2015. Consenting patients aged 20-40 years with no intraocular pathology who were seen for refractive errors were included. Ocular protrusion was measured using the Hertel exophthalmometer. Automatic refraction was done following cycloplegia with cyclopentolate and tropicamide. RESULTS: A total of 200 patients were included (68% females and 32% males). The mean age was 27.2±6 years. Hyperopia was the most common refractive error (51%), followed by hyperopic astigmatism (19.3%). EV varied between 9 mm and 23 mm, with a mean of 14.8±2.5 mm in the right eye and 15.0±2.5 mm in the left eye. The mean EVs were 17.10±2.80 mm in myopia, 14.24±1.92 mm in hyperopia, 16.72±2.58 mm in myopic astigmatism, 14.07±2.19 mm in hyperopic astigmatism, and 14.77±2.40 mm in mixed astigmatism. The spherical value had a negative correlation with EV (P=0.0000). CONCLUSION: The mean EV of this Cameroonian population is smaller than that of other populations and is consistent with the known characteristic hyperopic status of the population. A study on a larger sample will determine the normative data of absolute and relative EV in our setting.