Hertel exophthalmometry: Reliability and interobserver variation

Kashkouli, Mohsen Bahmani; Beigi, Bijan; Noorani, Mohammad Mahdi; Nojoomi, Marzieh

doi:10.1076/orbi.22.4.239.17245

Cited by 46 publications

(41 citation statements)

References 9 publications

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“…20 If the upper normal limit was defined as 2 standard deviations above the mean, the upper limit of normal Chinese in our study was 18.6 mm, which was lower than 21 mm that has traditionally been considered for Caucasians. Migliori and Gladstone 4 reported the upper limit of normal value was 20.1 mm for white women, 21.7 mm for white men, 23.0 mm for black women, and 24.7 mm for black men, which all were so different from what has been reported of the others 17.7 mm for the Japanese, 20 18.3 mm for Koreans, 19 19.3 mm for Iranians, 21 and 18.6 mm for the present study. The clinical significance is that an Asian patient with exophthalmometric reading within the upper normal limit of Caucasian measurements may consider advanced study to exclude TAO or other cause of exophthalmos.…”

Section: Discussionmentioning

confidence: 84%

Exophthalmos of patients with Graves' disease in Chinese of Taiwan

Tsai

Kau²,

Kao

et al. 2005

Eye

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Purpose To determine the exophthalmos measurements in patients with Graves' disease (GD) and to compare with those of normal subjects among the Chinese of Taiwan. Methods Hertel's exophthalmometry were performed in 163 consecutive adult GD patients and 419 normal subjects. The values of exophthalmos, asymmetry, and the distance between lateral orbital rims (base) were evaluated. Results There was a significant difference between GD and normal adults for exophthalmos and asymmetry, with GD patients demonstrating a mean exophthalmos of 18.32 mm and asymmetry of 0.93 mm as compared with 13.91 and 0.55 mm for normal subjects (Po0.001). The mean value of base for GD adults (106.52 mm) is slightly greater than normal subjects (105.82 mm). There was no gender difference in exophthalmometric value or asymmetry in each group. A total of 79 (48.5%) GD patients had exophthalmos greater than the upper limit of normal Chinese in Taiwan (18.6 mm). Asymmetry over 2 mm was observed in 11 (6.7%) patients with GD but in none of the normal subjects. Conclusions GD patients have significant exophthalmos and asymmetry compared to normal subjects. In comparison with previous studies, exophthalmos values for Chinese in Taiwan tend to be lower than those of Caucasians and black-American people, but are close to those of Korean, Japanese, Iranian, Indian, and Asian-American people. Adequate adjustment of normal and abnormal values of exophthalmos according to individual differences is important for the diagnosis of orbital morbidity and management of thyroid associated orbitopathy.

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Section: Discussionmentioning

confidence: 84%

Exophthalmos of patients with Graves' disease in Chinese of Taiwan

Tsai

Kau²,

Kao

et al. 2005

Eye

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“…Migliori and Gladstone (1984) reported the upper limit value in normal patients to be 20.1 mm for white women, 21.7 mm for white men, 23.0 mm for black women, and 24.7 mm for black men. Other reported upper limits of normal adults are 17.7 mm for Japanese (Amino et al, 1980), 18.3 mm for Koreans (Kim & Choi, 2001), 18.6 mm for Chinese (Tsai et al, 2005), and 19.3 mm for Iranians (Kashkouli et al, 2003). Anthropological difference may account for the varying normal values since the shape of the bony orbit is thought to vary with race (Tsai et al, 2005).…”

Section: Discussionmentioning

confidence: 92%

“…Exophthalmometry has been studied in normal adults and children of various races and ethnic backgrounds (Amino et al, 1980;Bolanos Gil de Montes et al, 1999;Fledelius & Stubgaard, 1986;Kashkouli et al, 2003;Kim & Choi, 2001;Knudtzon, 1949;Kumari Sodhi et al, 2001;Migliori & Gladstone, 1984;Mourits et al, 2004;Nucci et al, 1989). Migliori and Gladstone (1984) reported the upper limit value in normal patients to be 20.1 mm for white women, 21.7 mm for white men, 23.0 mm for black women, and 24.7 mm for black men.…”

Section: Discussionmentioning

confidence: 97%

Recognizing the Protruding Eye

Lin

Andreoli

Hatton

et al. 2008

Orbit

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Greater than half of the patients with 1-2 mm of exophthalmos appear as "normal" as the control patients. In comparison, the majority of patients with 4-5 mm of exophthalmos and nearly all the patients with 6 mm of exophthalmos and greater appear "abnormal." Our data suggests that the point at which exophthalmos becomes clinically perceptible to the majority of observers is 4 mm. There may be patients with 3 mm of exophthalmos and greater with orbital pathology being "missed" on cursory external examinations by general ophthalmologists, optometrists, and general practitioners.

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“…No entanto, esse limite varia conforme a população estudada: japoneses (17,7mm) (20) , coreanos (18,3mm) (7) , iranianos (19,3mm) (21) , e chineses (18,6mm) (15) . Observou-se neste estudo um limite superior de 20mm para os brancos e os pardos, e de 23mm para o grupo dos negros.…”

Section: Discussionunclassified

Valores da exoftalmometria média na população adulta da região do Grande ABC, São Paulo/Brasil

Moysés

Lucci

Júnior

et al. 2010

Rev. bras.oftalmol.

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RESUMOObjetivo: Estabelecer padrões de normalidade dos valores da exoftalmometria de ambos os olhos e da distância entre os rebordos orbitários laterais (base) em adultos jovens da população do Grande ABC São Paulo/Brasil. Métodos: Realizou-se a exoftalmometria com o exoftalmômetro de Hertel, em 129 pacientes do sexo feminino e 75 do sexo masculino, na faixa etária de 25 a 55 anos. Os pacientes foram separados em três grupos raciais (brancos, negros e pardos). Resultados: A variação da exoftalmometria encontrada na população em estudo foi de 10 a 23mm, média de 15,57 ±2,43mm. No sexo feminino a média foi de 15,42 ±2,40mm e no masculino, 15,83 ±2,47mm. Não se encontrou uma relação estatisticamente significativa entre os sexos feminino e masculino (p=0,25). Na raça branca a média foi de 15,57 ±2,46mm, na negra foi de 16,20 ±2,70mm e na parda foi de 15,02 ±2,01mm. A diferença foi estatisticamente significativa (p=0,008) entre as raças negra e parda. A medida da base variou de 104 a 125mm (média de 113,91 ±4,37mm). A diferença entre homens e mulheres foi estatisticamente significativa (p<0,001). Na raça branca a média da base encontrada foi de 112,18 ±4,02mm, na negra foi de 115,37 ±4,71mm e na parda, 115,18 ±3,66mm. A diferença da média da base foi estatisticamente significativa (p<0,001) entre as raças branca e negra e branca e parda. Nenhum paciente apresentou assimetria entre os dois olhos maior que 2mm. Conclusão: O padrão de normalidade da exoftalmometria encontrado para a população em estudo foi de 10 a 23mm e a base variou de 104 a 125mm.

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Hertel exophthalmometry: Reliability and interobserver variation

Abstract: Hertel exophthalmometry is a reliable method for measuring the ocular protrusion. However, as with most clinical measures, there is a negligible interobserver variation that seems to be unavoidable.

Cited by 46 publications

References 9 publications

Exophthalmos of patients with Graves' disease in Chinese of Taiwan

Exophthalmos of patients with Graves' disease in Chinese of Taiwan

Recognizing the Protruding Eye

Valores da exoftalmometria média na população adulta da região do Grande ABC, São Paulo/Brasil

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