J Korean Ophthalmol Soc.  2012 Jul;53(7):924-928. 10.3341/jkos.2012.53.7.924.

Usefulness of Exophthalmos Measurement on Upgaze

• Lee YH
• Lee JE
• Lee HJ
• Lee SB

• KMID: 2215848
• DOI: http://doi.org/10.3341/jkos.2012.53.7.924

Abstract

PURPOSE
To evaluate the usefulness of exophthalmos measurement on upgaze in patients who are not able to expose corneal vertex on primary gaze.
METHODS
The present study included 39 patients with blow out fracture, pseudotumor, or thyroid associated ophthalmopathy and 21 people who don't have any ocular disease. In total, 60 people had exophthalmometry using Hertel exophthalmometer on the basis of corneal vertex, inferior limbus, and inferior sclera by three examiners.
RESULTS
The relative exophthalmometry in normal group was 0.71 +/- 0.75 mm, 0.67 +/- 0.62 mm, and 0.69 +/- 0.60 mm on the basis of corneal vertex, inferior limbus, and inferior sclera, respectively. The relative exophthalmometry in exophthalmic group was 1.10 +/- 0.99 mm, 1.13 +/- 0.99 mm, 1.10 +/- 0.91 mm on the basis of corneal vertex, inferior limbus, and inferior sclera, respectively. The relative exophthalmometry in enophthalmic group was 0.79 +/- 0.90 mm, 0.74 +/- 0.92 mm, 0.74 +/- 0.87 mm on the basis of corneal vertex, inferior limbus, and inferior sclera, respectively. There was no statistically significant difference between different measuring points (p > 0.05). The inter-examiner reproducibility was shown to be highly reliable.
CONCLUSIONS
The upgaze exophthalmometry on the basis of inferior limbus or inferior sclera would be useful in the patients who are not able to expose corneal vertex on primary gaze.

Keyword

Hertel exophthalmometry; Reproducibility; Upgaze exophthalmometry

MeSH Terms

Exophthalmos
Graves Ophthalmopathy
Humans
Sclera

Figure

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  Figure 1 (A) Front photograph of patient with thyroid associated ophthalmopathy showing eyelid swelling and exophthalmos. (B) Side photograph that upper eyelid covers corneal vertex on primary gaze. (C) Inferior limbus is exposed easily on upgaze.

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  Figure 2 The intersections (crosses) between horizontal (white) and vertical (black) lines are read into exophthalmometry at different ocular measuring points. (A) Corneal vertex, (B) Inf. limbus, (C) Inf. sclera. The more upside he gazes, the smaller exophthalmometry is.

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