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Ocular Differential Diagnosis
Eighth Edition
 Ocular Differential Diagnosis

Eighth Edition

Frederick Hampton Roy, M.D., F.A.C.S.

Little Rock, Arkansas
© 2007 by Frederick Hampton Roy

Published by F.E.P. International

All rights reserved. This book is protected by copyright. No part of this book may
be reproduced in any form or by any means, including photocopying, or utilized by any
information storage and retrieval system without written permission from the copyright
owner, except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as U.S.
government employees are not covered by the above-mentioned copyright.

Previous editions: 1972, 1977, 1982, 1987, 1992, 1997, 2002

Printed in the USA

ISBN X-XXXX-XXXX-X

Care has been taken to confirm the accuracy of the information presented and to
describe generally accepted practices. However, the author and publisher are not
responsible for errors or omissions or for any consequences from application of the
information in this book and make no warranty, expressed or implied, with respect to the
currency, completeness, or accuracy of the contents of the publication. Application of this
information in a particular situation remains the professional responsibility of the
practitioner.
The author and publisher have exerted every effort to ensure that drug selection
and dosage set forth in this text are in accordance with current recommendations and
practice at the time of publication. However, in view of ongoing research, changes in
government regulations, and the constant flow of information relating to drug therapy and
drug reactions, the reader is urged to check the package insert for each drug for any
change in indications and dosage and for added warnings and precautions. This is
particularly important when the recommended agent is a new or infrequently employed
drug.
Some drugs and medical devices presented in this publication have Food and
Drug Administration (FDA) clearance for limited use in restricted research settings. It is
the responsibility of the health care provider to ascertain the FDA status of each drug or
device planned for use in their clinical practice.
 To Mary Michelle
To my children:
Nichols, Robert, Kimberly, Frederick, Jr., Charles, and Helena
To Dr. Arlington Krause,
molder and questioner in my early formative academic life
To Dr. Philip Lewis and Dr. Roger Hiatt
for guidance and direction
 ============= Contents =============

Preface ix

How to Use This Book xi

I. Regional Signs and Symptoms

1. Orbit 3
2. Lids 45
3. Lacrimal System 110
4. Extraocular Muscles 127
5. Conjunctiva 183
6. Globe 220
7. Sclera 231
8. Cornea 241
9. Intraocular Pressure 305
10. Anterior Chamber 329
11. Pupil 344
12. Iris 364
13. Lens 386
14. Vitreous 421
15. Retina 433
16. Choroid 526
17. Optic Nerve 559
18. Visual-Field Defects 604

II. General Signs and Symptoms

19. Visual Disturbance 619
20. Visual Complaint 644
21. Head Position 665
Subject Index 669
 Preface

The first edition of Ocular Differential Diagnosis was published in 1972, and
various editions have been translated in Spanish, Turkish, Chinese, Portuguese, and
Italian. All previous editions have been my work. Dr. Gonzolo Murillo of La Paz,
Bolivia, helped in edition four and five with the diagnostic decision tables. In edition six,
section editors helped to standardize the language and made helpful suggestions. I feel
this is the best edition of Ocular Differential Diagnosis thus far. This text would not have
been possible without the superb efforts of Renee Tindall, Dr. Fernando Murillo, Angie
Brown, and Dr. Kae Chatman.
The Ocular Differential Diagnosis book provides comprehensive lists of causes
for symptoms or findings. Frequently more information is needed and hopefully Ocular
Syndromes and Systemic Diseases will furnish additional information to make a better
diagnosis. I hope the ophthalmologist and optometrist using this book will bring any
errors in this edition to my attention.

Frederick Hampton Roy, M.D.

Little Rock, Arkansas
 How to Use This Book
This book can be used easily and quickly by following the directions presented
below.

1. If the sign or symptom relates to a particular region of the eye, turn to the table of
contents preceding this page to find the number of the page on which listings of the
signs and symptoms pertaining to the specific region begins. This latter page (or those
immediately following) will refer the user to that (or those) on which the various
causes of the condition are listed. For example, let us assume that the patient has
pigmentation of the cornea. The table of contents on page vii shows that the cornea
section begins on page 241. Turning to page 241 the user finds references to page 248
on which the causes of corneal pigmentation are listed according to type. In the subject
index, this topic is listed as Cornea, pigmentation of, 248.
2. If the symptom, such as binocular diplopia or night blindness, does not relate to a
particular region of the eye, look for it either in the subject index at the back of the
book or under General Signs and Symptoms beginning on page 619.
Various features of a disease may be crosschecked. For instance, a "pulsating
exophthalmos with orbital bruit and conjunctival edema" may be sought under orbit,
page 3, where the user of the book is referred to exophthalmos, page 4, and orbital
bruit, page 31, and under conjunctiva, page 183, where the user is referred to
conjunctival edema, page 202. The terms "exophthalmos," "orbital bruit" (under orbit,
bruit of) and "conjunctival edema" (under conjunctiva, edema of) may also be found in
the subject index. Terms such as "secondary glaucoma" are indexed under the noun,
e.g., glaucoma, secondary.
3. Following some of the differential diagnosis lists are diagnostic decision tables. These
tables list the history, physical signs, and laboratory tests that differentiate each
possible diagnosis. These can be identified in the subject index because they are
followed by a t.
Ocular Differential Diagnosis
Eighth Edition

PART I
Regional Signs and Symptoms
 1
Orbit

CONTENTS
Pseudoproptosis 4
Exophthalmos 4
Syndromes and diseases associated with exophthalmos 8
Specific exophthalmos 11
Diagnostic tables 16
Up to one year 16
One to five years 17
Five to ten years 19
Ten to thirty years 21
Thirty to fifty years 22
Fifty to seventy years 24
More than seventy years 26
Pulsating exophthalmos 28
Recurrent exophthalmos 29
Enophthalmos 15
Intraorbital calcifications 31
Orbital bruit 31
Diagnostic table 32
Orbital emphysema 33
Orbital pain 33
Shallow orbits or diminished orbital volume 34
Pseudohypertelorism 35
Hypertelorism 35
Hypotelorism 38
Deep-set eyes 38
Prominent supraorbital ridges 38
Osteolysis of bony orbit 39
Fossa formation of orbit 39
Subperiosteal orbital hemorrhage 39
Orbital hemorrhage 40
Expansion of orbital margins 40
Hypertrophy of orbital bones 40
Expansion of optic canal 41
Small optic canals 41
Erosion of optic canal 42
Enlargement of superior orbital fissure 42
Narrowing of superior orbital fissure 43
Small orbit 43
Large orbit 43
Hematic orbital cysts 43
 PSEUDOPROPTOSIS (APPEARANCE OF EXOPHTHALMOS)
*1. Asymmetry of bony orbits
2. Congenital cystic eyeball
*3. Contralateral enophthalmos (see p. 15)
4. Facial asymmetry as progressive facial hemiatrophy (Parry-Romberg syndrome)
5. Harlequin orbit (shallow orbit with arched superior and lateral wall) as with
hypophosphatasia
6. Hypoplastic supraorbital ridges as in trisomy (Edward syndrome)
7. Retraction of upper lid as with thyroid disease
8. Slight blepharoptosis as with Homer syndrome of contralateral eye
9. Shallow orbit as in Crouzon disease (craniofacial dysostosis)
10. Unilateral congenital glaucoma
11. Unilateral high-axial myopia
12. Unilateral secondary glaucoma resulting from ocular trauma during childhood

Newell FW. Ophthalmology: principles and concepts, 7th ed. St. Louis: CV Mosby,
1992.

Rootman J. Diseases of the orbit. Philadelphia: JB Lippincott, 1988.

EXOPHTHALMOS
1. Drugs, including the following:
adrenal cortex injection hydrocortisone methylthiouracil
aldosterone iodide and iodine oral contraceptives
beclomethasone solution and paramethasone
betamethasone compounds poliovirus vaccine
carbimazole levothyroxine prednisolone
cocaine liothyronine prednisone
cortisone liotrix propranolol
desoxycorticosterone lithium carbonate propylthiouracil
dexamethasone medrysone radioactive iodides
dextrothyroxine succinylcholine thyroglobulin
fludrocortisone meprednisone thyroid
fluorometholone methimazole triamcinolone
flu-prednisolone methylprednisolone vitamin A

2. Inflammation
A. Acute-orbital cellulitis
B. Acute suppurative-mucormycosis (diabetic or debility)
C. Allergic fungal sinusitis
D. Benign lymphoepithelial lesion (Mikulicz disease)
*E. Chronic (nongranulomatous-pseudotumor)
F. Chronic (granulomatous-tuberculosis, sarcoid (Schaumann syndrome), syphilis
(lues), parasites, aspergillosis)
G. Relapsing polychondritis
3. Injuries
 A. Foreign body
B. Orbital hemorrhage
C. Orbital roof fracture
D. Secondary carotid cavernous sinus fistula
E. Thermal bums
4. Systemic disease
A. Acute intracranial hypertension
B. Amyloidosis (Lubarsch-Pick syndrome)
C. Chloroma
D. Cretinism (hypothyroidism)
E. Hydrocephalus and ventriculoperitoneal syndrome
F. Hypervitaminosis A
G. Hypophosphatasia (phosphoethanolaminuria)
*H. Thyroid disorder
I. Myasthenia gravis (Erb-Goldflam syndrome)
J. Obesity
5. Tumors
A. Cartilaginous tumors
(1) Cartilaginous hamartoma
(2) Chondroma
(3) Chondrosarcoma
(4) Mesenchymal chondrosarcoma
B. Cystic lesions
(1) Colobomatous cyst
(2) Dermoid cyst
(3) Hematocele
(4) Hydatid cyst
(5) Meningocele and meningoencephalocele
(6) Mucocele
(7) Optic nerve sheath cyst
(8) Simple epithelial cyst
(9) Teratoma
C. Fibrocytic tumors
(1) Fibroma
(2) Fibrosarcoma
(3) Fibrous histiocytoma
(4) Juvenile fibromatosis
(5) Nodular fasciitis
D. Histiocytic lesions
(1) Others
a. Juvenile xanthogranuloma (JXG, nevoxanthoendothelioma)
b. Sinus histiocytosis with massive lymphadenopathy
(2) Systemic histiocytoses (histiocytosis X) (Hand-Schüller-Christian
disease)
E. Inflammatory pseudotumor of orbit
(1) Ectopic cerebellar tissue in orbit
 (2) Local, such as fungus or foreign body
(3) Systemic such as sarcoidosis syndrome (Schaumann syndrome) or
collagen disease
(4) Unknown cause
F. Lacrimal gland (fossa) lesions
(1) Epithelial tumors
a. Adenoid cystic carcinoma
b. Mucoepidermoid carcinoma
c. Pleomorphic adenocarcinoma (malignant mixed tumor)
d. Pleomorphic adenoma (benign mixed tumor)
(2) Nonepithelial lesions
a. Infectious
b. Inflammatory
c. Lymphoid and leukemia
d. Systemic (sarcoid)
G. Lipocytic and myxoid tumors
(1) Lipoma
(2) Liposarcoma
(3) Myxoid liposarcoma
(4) Myxoma
H. Lymphoid tumors and leukemias (excluding lacrimal gland lesions)
(1) Benign reactive lymphoid hyperplasia
(2) Burkitt lymphoma
(3) Lymphoblastic leukemia
(4) Myelogenous leukemia (granulocytic sarcoma)
(5) Non-Hodgkin lymphoma
I. Metastatic tumors of the orbit
(1) Malignant melanoma of skin
(2) Neuroblastoma (child)
(3) Other sites such as Ewing sarcoma
(4) Primary in breast (adult female)
(5) Primary in lung (adult male)
(6) Primary in prostate (adult male)
J. Nonepithelial lesions
(1) Benign reactive lymphoid hyperplasia
(2) Inflammatory pseudotumors (dacryoadenitis)
(3) Lymphoma
(4) Plasmacytoma
K. Optic nerve and meningeal tumors
(1) Juvenile pilocytic astrocytoma (optic nerve glioma)
(2) Meningioma
a. Primary optic nerve sheath
b. Secondary
(3) Malignant optic nerve glioma
L. Osseous and fibroosseous tumors
(1) Aneurysmal bone cyst
 (2) Benign osteoblastoma
(3) Brown tumor of hyperparathyroidism
(4) Fibrous dysplasia (Albright syndrome)
(5) Giant cell granuloma
(6) Giant cell tumor (osteoclastoma)
(7) Infantile cortical hyperostosis
(8) Ossifying fibroma
(9) Osteoma
(10) Osteosarcoma
M. Peripheral nerve tumors
(1) Alveolar soft-part sarcoma
(2) Amputation neuroma
(3) Granular cell myoblastoma
(4) Neurilemoma
a. Benign
b. Malignant
(5) Neurofibroma
a. Plexiform
b. Solitary
(6) Paraganglioma (chemodectoma)
N. Primary melanocytic tumors
(1) Blue nevus
(2) Melanocytic hamartoma
(3) Melanotic progonoma (retinal tumor)
(4) Primary orbital melanoma
O. Rhabdomyoma and rhabdomyosarcoma
(1) Rhabdomyoma
(2) Rhabdomyosarcoma
P. Secondary orbital tumors from adjacent structures
(1) Conjunctival origin
a. Melanoma
Mucoepidermoid
c. Squamous cell carcinoma
(2) Eyelid origin
a. Basal cell carcinoma
b. Melanoma
c. Sebaceous carcinoma
d. Squamous cell carcinoma
(3) Intracranial origin
a. Astrocytoma
b. Meningioma
(4) Intraocular origin
a. Medulloepithelioma
b. Neurilemoma
c. Retinoblastoma
d. Uveal melanoma
 (5) Nasopharyngeal origin
a. Angiofibroma
b. Carcinoma
c. Melanoma
(6) Paranasal sinus origin
a. Ethmoid sinus carcinoma
b. Inverting papilloma
c. Maxillary sinus carcinoma
d. Rhabdomyosarcoma
Q. Vasculogenic lesions
(1) Capillary hemangioma
(2) Cavernous hemangioma
(3) Hemangiopericytoma
(4) Hemangiosarcoma
(5) Kaposi sarcoma
(6) Lymphangioma
(7) Varices
(8) Vascular leiomyoma
(9) Vascular leiomyosarcoma
6. Vascular disorders
A. Allergic vasculitis
B. Angioedema (Quincke disease)
C. Arteriovenous aneurysm or varices
D. Arteriovenous fistula (varicose aneurysm)
E. Collagen disease-lupus erythematosus (Kaposi-Libman-Sacks syndrome),
periarteritis nodosa (Kussmaul disease), or dermatomucomyositis (Wagner-Unver-
richt syndrome)
F. Cranial arteritis
G. Thrombophlebitis
H. Scurvy causing bilateral orbital hemorrhage

Archer KF, et al. Orbital nonchromaffin paraganglioma. Ophthalmology 1989; 96:1659-

1666.

Carter K, et al. Ophthalmic manifestations of allergic fungal sinusitis. Am J OphthalmoI

1999; 127:189-195.

Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA:
Butterworth-Heinemann, 2001.

Luxenberg MN. Chloroma. Arch Ophthalmol 1991; 109:734-736.

Lyon DB, et al. Epithelioid hemangioendothelioma of the orbital bones. Ophthalmology

1993; 99:1773-1778.

Newman NJ, et al. Ectopic brain in the orbit. Ophthalmology 1986; 93:268-272.
Shields JA, et al. Classification and incidence of space-occupying lesions of the orbit.
Arch Ophthalmol 1984; 102:- 1606-1611.

Sloan B, et al. Scurvy causing bilateral orbital hemorrhage. Arch OphthalmoI 1999;
117:842.

SYNDROMES AND DISEASES ASSOCIATED WITH EXOPHTHALMOS

1. Actinomycosis
2. Albright syndrome (fibrous dysplasia)
3. Amyloidosis (Lubarsch-Pick syndrome)
4. Apert syndrome (sphenoacrocraniosyndactyly)
5. Arteriovenous fistula (varicose aneurysm)
6. Aspergillosis
7. Bacillus cereus
8. Bloch-Sulzberger disease (incontinentia pigment I)
9. Bonnet-Dechaume-Blanc syndrome (neuroretinoangiomatosis syndrome)
10. Bourneville syndrome (tuberous sclerosis)
11. Caffey syndrome (infantile cortical hyperostosis)
12. Carotid artery-cavernous sinus fistula
13. Clostridium perfringens
14. Coenurosis
15. Craniostenosis
16. Cretinism (hypothyroidism)
17. Crouzon disease (craniofacial dysostosis)
18. Cryptococcosis
19. Cushing syndrome (adrenocortical syndrome)
20. Dejean sign (orbital floor fracture)
21. de Lange syndrome (congenital muscular hypertrophy-cerebral syndrome)
22. Dermatomucomyositis (polymyositis dermatomyositis)
23. Dermoid
24. Diencephalic epilepsy syndrome (autonomic epilepsy syndrome)
25. Dirofilariasis
26. Dracontiasis (Guinea worm infection)
27. Engelmann syndrome (diaphyseal dysplasia)
28. Ewing sarcoma
29. Feer disease (infantile acrodynia)
30. Fibrosarcoma
31. Fibrous dysplasia (Albright syndrome)
32. Foix syndrome (cavernous sinus thrombosis)
33. Gardner syndrome
34. Grönblad-Strandberg syndrome (pseudoxanthoma elasticum)
35. Hallermann-Streiff-François syndrome (oculomandibulofacial dyscephaly)
36. Hand-Schüller-Christian disease (histiocytosis X)
37. Heerfordt syndrome (uveoparotid fever)
38. Hemangiomas
39. Herpes zoster
40. Hodgkin disease
41. Hollenhorst syndrome (chorioretinal infarction syndrome)
42. Homer syndrome (cervical sympathetic paralysis syndrome)
43. Hunter syndrome (MPS [mucopolysaccharidosis] II)
44. Hurler (MPS I-H) syndrome
45. Hutchinson disease (adrenal cortex neuroblastoma with orbital metastasis)
46. Hydatid cyst
47. Hydrocephalus chondrodystrophicus congenita (extreme hydrocephalus syndrome)
48. Hypertension
49. Hyperthyroidism (Basedow syndrome)
50. Hypervitaminosis A
51. Hypophosphatasia (phosphoethanolaminuria)
52. Jansen disease (metaphyseal dysostosis)
53. JXG (nevoxanthoendothelioma)
54. Kleeblattschädel syndrome (cloverleaf skull)
55. Leiomyoma
56. Leopard syndrome (multiple lentigines syndrome)
57. Leprechaunism
58. Leukemia
59. Linear nevus sebaceous of Jadassohn
60. Lupus erythematosus (Kaposi-Libman-Sacks syndrome)
61. Lymphoid hyperplasia
62. Lymphangioma
63. Lymphosarcoma
64. Melnick-Needles syndrome (osteodysplasty)
65. Meningioma
66. Mikulicz syndrome (dacryosialoadenopathy)
67. Möbius disease (congenital paralysis of sixth and seventh nerves)
68. Mucocele
69. Mucormycosis
70. Multiple myeloma
71. Mumps
72. Myasthenia gravis (Erb-Goldflam syndrome)
73. Neurilemoma
74. Noonan syndrome (male Turner syndrome)
75. Osteopetrosis (Albers-Schönberg syndrome)
76. Paget syndrome (osteitis deformans)
77. Periarteritis nodosa (Kussmaul syndrome)
78. Periocular and ocular metastatic tumors
79. Pfeiffer syndrome
80. Pierre-Robin syndrome (micrognathia-glossoptosis syndrome)
81. Progeria (Hutchinson-Gilford syndrome)
82. Pyknodysostosis
83. Quincke disease (angioedema)
84. Relapsing polychondritis
85. Retinoblastoma
86. Rhabdomyosarcoma
87. Rochon-Duvigneaud syndrome (superior orbital fissure syndrome)
88. Rollet syndrome (orbital apex-sphenoidal syndrome)
89. Sarcoidosis syndrome (Schaumann syndrome)
90. Scaphocephaly syndrome
91. Scheie syndrome (MPS I-S)
92. Scurvy (avitaminosis C)
93. Sebaceous gland carcinoma
94. Seckel syndrome (bird-headed dwarf syndrome)
95. Sézary syndrome (mycosis fungoides syndrome)
96. Shy-Gonatas syndrome (orthostatic hypotension syndrome)
97. Siegrist sign (pigmented choroidal vessels)
98. Silverman syndrome (battered baby syndrome)
99. Sphenocavernous syndrome
100. Streptococcus
101. Sturge-Weber syndrome (encephalofacial angiomatosis)
102. Syphilis (lues)
103. Thermal bums
104. Trichinellosis
105. Trisomy syndrome (Edward syndrome)
106. Tuberculosis
107. Turner syndrome (gonadal dysgenesis)
108. von Hippel-Lindau syndrome (retinocerebral angiomatosis)
109. von Recklinghausen disease (neurofibromatosis)
110. Wegener syndrome (Wegener granulomatosis)

Goodman RM, Gorlin RJ. The face in genetic disorders. 51. Louis: CV Mosby, 1970.

Miller NR, et al. Lytic Paget disease as a cause of orbital cholesterol granuloma. Arch
Ophthalmol I999; 117: 1084-1085.

Roy PH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott
Williams & Wilkins, 2002.

SPECIFIC EXOPHTHALMOS
1. Age
A. Newborn-most common
*(1) Orbital sepsis
(2) Orbital neoplasm including congenital malignant teratoid neoplasm
B. Neonatal-osteomyelitis of the maxilla
C. Early childhood (up to 1 year of age-most common)
*(1) Dermoid
*(2) Hemangioma
(3) Dermolipoma
 (4) Histiocytosis X including Hand-Schüller-Christian disease
*(5) Orbital extension of retinoblastoma
D. One to five years-most common
*(1) Dermoid
(2) Metastatic neuroblastoma
(3) Rhabdomyosarcoma
(4) Epithelial cyst, such as sebaceous cyst and epithelial inclusion cyst
(5) Glioma of optic nerve
(6) Sphenoid wing meningioma
*(7) Orbital extension of retinoblastoma
(8) Fibrous dysplasia (Albright syndrome)
(9) Metastatic embryonal sarcoma
*(10) Hemangioma
E. Five to ten years-most common
(1) Pseudotumor
(2) Orbital extension of retinoblastoma
(3) Malignant lymphomas and leukemias
*(4) Dermoid
*(5) Hemangioma
(6) Meningioma
(7) Fibrous dysplasia (Albright syndrome)
(8) Rhabdomyosarcoma
(9) Orbital hematoma
(10) Glioma of optic nerve
F. Ten to thirty years-most common
*(1) Pseudotumor
(2) Mucocele
(3) Meningioma
*(4) Endocrine ophthalmopathy (thyroid-related ophthalmopathy)
(5) Lacrimal gland tumor
(6) Malignant lymphomas and leukemias
(7) Dermoid
(8) Hemangioma
(9) Peripheral nerve tumors
(10) Undifferentiated sarcomas
(11) Osteoma
(12) Fibrous dysplasia (Albright syndrome)
(13) Rhabdomyosarcoma
(14) Glioma of optic nerve
G. Thirty to fifty years-most common
*(1) Pseudotumor -
(2) Mucocele
(3) Malignant lymphomas and leukemias
*(4) Hemangioma
*(5) Endocrine ophthalmopathy (thyroid-related ophthalmopathy)
(6) Lacrimal gland tumors
 (7) Rhinogenic carcinoma
(8) Malignant melanoma
(9) Osteosarcoma
(10) Fibrosarcoma
(11) Metastatic carcinoma
(12) Meningioma
(13) Dermoid
H. Fifty to seventy years-most common
*(1) Pseudotumor
*(2) Mucocele
*(3) Malignant lymphomas and leukemias
(4) Dermoid
(5) Carcinoma of palpebral or epibulbar origin
*(6) Meningioma
*(7) Endocrine ophthalmopathy (thyroid-related ophthalmopathy)
(8) Lacrimal gland tumor
(9) Osteosarcoma
(10) Fibrosarcoma
(11) Undifferentiated sarcoma
(12) Metastatic carcinoma
(13) Osteoma
(14) Fibrous dysplasia (Albright syndrome)
(15) Neurofibroma
(16) Hemangioma
I. More than seventy years-most common
(1) Melanoma
(2) Pseudotumor
*(3) Lymphoma
*(4) Metastatic tumor
(5) Basal cell carcinoma
(6) Mucocele
2. Unilateral exophthalmos-most common
A. Anatomical conditions
(1) Unilateral myopia of high degree
(2) Defects in the vault of the orbit: meningocele, encephalocele,
hydroencephalocele
(3) Exophthalmos associated with arterial hypertension
(4) Recurrent exophthalmos from retrobulbar hemorrhage, lymphangioma
(5) Intermittent exophthalmos associated with venous anomalies within
the cranium
(6) Disease of the pituitary gland; meningiomas involving sphenoid ridge
*(7) Unilateral exophthalmos associated with endocrine or thyroid-related
ophthalmopathy
B. Traumatic conditions
(1) Contralateral floor fracture with enophthalmos
(2) Fracture of the orbit with retrobulbar hemorrhage
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