As I collected material for this symposium, I wondered how many conditions might produce exophthalmos, for treatment can be chosen more rationally if a definite cause for ocular protrusion can be established. I consulted the oracle, Sir Stewart Duke-Elder, and found that more than 70 distinct entities were listed in his textbooks of ophthalmology as capable of producing exophthalmos. Obviously, one cannot go through the mental calisthenics necessary to make a differential diagnosis among such a large number of disorders every time a patient who has exophthalmos walks into the office.
To simplify diagnosis and the approach to therapy, I consider only four general categories when I am confronted with exophthalmos. I ask myself four questions: "Is it inflammatory?" "Might it be a vascular anomaly?" "Could it be metabolic exophthalmos?" "What about the possibility of tumor?" Once the case is catalogued into one of these four groups, the problem of
HENDERSON JW. Treatment of Exophthalmos from the Ophthalmologist's Viewpoint. AMA Arch Ophthalmol. 1956;56(5):678-684. doi:10.1001/archopht.1956.00930040686005