Orbital Tumors

Orbital Tumors

Alison V. Crum

Samantha F. Bordonaro


There are many types of orbital tumors or masses that can occur in and around the orbit. The diagnosis and management can vary greatly depending on the cause. Owing to the potentially slow progression of this type of orbital disease, diagnosis can be difficult, and exam findings may be extremely subtle. The urgency required in terms of identification and treatment may also vary, making it important for any type of provider to have some baseline knowledge about orbital tumors and their identification and early management.


Findings related to orbital tumors on exam may be subtle and may have developed over time, making it difficult for the patient to have noticed much change. On exam, looking at the position of the eyeballs within the face and determining whether the face appears completely symmetric is an important place to start (Figure 29.6).

In the emergency department (ED) or urgent care center, providers may have access only to rulers. However, more sophisticated devices for a more objective symmetry assessment may be available with the McCoy facial trisquare or Hertels exophthalmometer (Figure 29.7).

Assessing the patient with a “worm’s eye view” may also be helpful. This is when you have the patient look up to the ceiling and view the face from the chin looking upward (Figure 29.8).

When approaching the exam, consider “the P’s” of orbital lesions.4


Proptosis describes one eye being farther forward in the eye socket than normal. There are two types of proptosis to recognize. Axial proptosis occurs owing to thyroid orbitopathy or thyroid eye disease. You can assess firmness of proptosis with “resistance to retropulsion.” Have the patient close their eyes, and with equal pressure from your two thumbs, press gently onto their upper eyelid. The globe will move posteriorly into the eye socket. This can be described as “soft” or “no resistance to retropulsion,” like compressing a grape or cherry tomato. Patients’ upper lids with orbital

masses or thyroid orbitopathy will resist your thumb’s pressure and will feel harder, like pressing on your chin/on a bone. This can be described as “moderate to severe resistance to retropulsion.”

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Nov 11, 2022 | Posted by in EMERGENCY MEDICINE | Comments Off on Orbital Tumors

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