Orbit Examination
            1. Observe
              •     lid retraction
              •     arterialisation of scleral vessels
            2. Confirm proptosis from side and behind and above

            3. Measure with Hertel's exophthalmometer

            4. Use ruler to assess if proptosis is axial or non-axial

            5. Palpate the orbit for:

              •     mass
              •     retropulsion
            6. Test ocular motility

            7. Other:

              •      listen for bruit
              •      test optic nerve function
            The most common case in orbit examination is thyroid eye disease. However, do not forget the differential diagnosis of proptosis. The mnemonic VEIN allows easy recall:
             
            •  V = vascular for eg. cavernous fistula, cavernous haemangioma
            •   E = endocrine as in thyroid eye diseases
            •   I  = inflammatory or infectious conditions such as orbital cellulits.  It is unlikely that you would get acute patient in fellowship / membership examination
            •  N = neoplastic which has a wide differential diagnosis including optic nerve glioma, meningioma, lacrimal gland  tumour or mucocele from the frontal sinus etc.
            Back to the index for final MRCOphth

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