Kinetic observational exophthalmometry: a simple clinical method of assessing the relative axial positions of the eyes

Abstract

A simple clinical method for detecting the presence of unilateral proptosis or enophthalmos is described. It is important that in a patient with orbital disease, a detailed ophthalmic and orbital history be taken and a careful clinical evaluation be performed. In the clinical assessment of such a patient, it is also essential to determine the presence of any asymmetry of eye position after excluding any asymmetry in eye size or in the skeletal structure of the face. Observation of the patient's head from above and noting the relative positions of the two eyes has been the traditional method in the clinical assessment of proptosis. We believe that this method of assessment of proptosis has not been adequately described or fully exploited in the past. This paper describes an extension of the same technique. It involves the examiner making the observation from above while slowly moving the patient's head passively from a position of neck flexion to one of neck extension, and then noting which eye in a patient comes into view first. We believe that this kinetic technique provides an accurate method of noting any asymmetry in eye position in relation to the supraciliary ridge. It should therefore prove to be a clinically useful method in the initial assessment of a patient with suspected ocular displacement.