Parallax-free Exophthalmometry: A Comprehensive Review of the Literature on Clinical Exophthalmometry and the Introduction of the First Parallax-Free Exophthalmometer

Genders, Stijn W.; Mourits, Daphne L.; Jasem, Mohammad; Kloos, Roel; Saeed, Peerooz; Mourits, Maarten P.

doi:10.3109/01676830.2014.963877

Cited by 20 publications

(16 citation statements)

References 13 publications

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“…It is possible the Mourits agreement may have been better if the clinician were positioned in front of the patient. 25 However, given that measurements made with the Hertel and Oculus instruments (patient upright) showed ideal intra-clinician, inter-clinician agreement, and ideal or nearly ideal agreement with CT for both right and left sides, we recommend that clinicians continue to sit to the right of the patient.…”

Section: Discussionmentioning

confidence: 97%

“…2,9,10,11,12,13,14 Exophthalmometer design and user technique affect accuracy and reproducibility. 3,16, 25 Interobserver variability is common. 17,18 …”

Section: Discussionmentioning

confidence: 99%

“…Measurements were performed as described by Frueh et al with the clinician seated to the patient’s right for the upright position and standing at the head of the patient for the supine position. 6, 25 In addition to exophthalmometry, each clinician made three horizontal fissure measurements using a standard ruler (Figure 1). …”

Section: Methodsmentioning

confidence: 99%

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Axial Globe Position Measurement

Bingham

Sivak-Callcott

Gurka

et al. 2016

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose Identify a reproducible measure of axial globe position (AGP) for multicenter studies of patients with thyroid eye disease (TED). Methods This is a prospective, international, multicenter, observational study in which 3 types of AGP evaluation were examined: radiologic, clinical, and photographic. In this study, computed tomography (CT) was the modality to which all other methods were compared. CT AGP was measured from an orthogonal line between the anterior lateral orbital rims to the cornea. All CT measurements were made at a single institution by 3 individual clinicians. Clinical evaluation was performed with exophthalmometry. Three clinicians from each clinical site assessed AGP with 3 different exophthalmometers and horizontal palpebral width using a ruler. Each physician made 3 separate measurements with each type of exophthalmometer, not in succession. All photographic measurements were made at a single institution. AGP was measured from lateral photographs in which a standard marker was placed at the anterior lateral orbital rim. Horizontal and vertical palpebral fissure were measured from frontal photographs. Three trained readers measured 3 separate times, not in succession. Exophthalmometry and photography method validity was assessed by agreement with CT (mean differences calculation, ICC’s, Bland-Altman figures). Correlation between palpebral fissure and CT AGP was assessed with Pearson correlation. Intraclinician and interclinician reliability was evaluated using intraclass correlation coefficients (ICC). Results Sixty-eight patients from 7 centers participated. CT mean AGP was 21.37mm (15.96 – 28.90mm) right, 21.22mm (15.87 – 28.70mm) left (ICC 0.996 and 0.995). Exophthalmometry AGP fell between 18mm and 25mm. Intraclinician agreement across exophthalmometers was ideal (ICC 0.948 – 0.983). Agreement between clinicians was greater than 0.85 for all upright exophthalmometry measurements. Photographic mean AGP was 20.47mm (10.92 – 30.88mm) right, 20.30mm (8.61 – 28.72mm) left. Intrareader and interreader agreement was ideal (ICC 0.991 – 0.989). All exophthalmometers’ mean differences from CT ranged between −0.06mm (+/− 1.36mm) and 0.54mm (+/− 1.61mm); 95% CI fell within 1mm. Magnitude of AGP did not affect exophthalmometry validity. Oculus best estimated CT AGP but differences form other exophthalmometers were not clinically meaningful in upright measurements. Photographic AGP (right ICC=0.575, left ICC=0.355) and palpebral fissure do not agree with CT. Conclusions Upright clinical exophthalmometry accurately estimates CT AGP in TED. AGP measurement was reliably reproduced by the same clinician and between clinicians at multiple institutions using the protocol in this study. These findings allow reliable measurement of AGP that will be of considerable value in future outcome studies.

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Section: Discussionmentioning

confidence: 97%

“…2,9,10,11,12,13,14 Exophthalmometer design and user technique affect accuracy and reproducibility. 3,16, 25 Interobserver variability is common. 17,18 …”

Section: Discussionmentioning

confidence: 99%

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Axial Globe Position Measurement

Bingham

Sivak-Callcott

Gurka

et al. 2016

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…All patients underwent ophthalmic examination on the first day of trauma, at 1 week after trauma (before surgery), and at 3 months after surgery. The degree of enophthalmos was measured by one skilled physician (HBL) using a Hertel exophthalmometer, according to the guidelines [5,6]: (1) Patients were positioned upright, with the patient’s eye level at the examiner’s eye level. (2) The precise location of the lateral orbital rim was marked using a surgical pen.…”

Section: Methodsmentioning

confidence: 99%

“…The exophthalmometer measures the distance between the lateral orbital rim and the most anterior position of the cornea. However, the method is often associated with low accuracy and poor reproducibility [5,6], due to (1) improper location of the footplate on the lateral orbital rim, (2) rotation of the instrument at the horizontal plane, or (3) parallax error [7]. Nevertheless, it is widely used in clinical practice because of its simplicity, and accuracy can be improved if the device is used by an experienced examiner.…”

Section: Introductionmentioning

confidence: 99%

New anthropometric data for preoperative planning in orbital wall fracture treatment: the use of eyelid drooping

Lee

2018

Arch Craniofac Surg

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BackgroundThe presence of enophthalmos is an important determinant in the decision of orbital wall fracture surgery. We proposed eyelid drooping as a new anthropometric diagnostic measure and analyzed whether eyelid drooping is associated with enophthalmos.MethodsThis retrospective study was performed from January 2014 to December 2016. A total of 75 patients with blowout fractures were studied. One experimenter measured the degree of enophthalmos using a Hertel exophthalmometer at 1 week after trauma and at 3 months after surgery. The height change of the upper eyelid was measured using the marginal reflex distance (MRD) on both sides, and the degree of eyelid drooping was calculated by comparing the two lengths. We analyzed statistically the correlation between enophthalmos and eyelid drooping. ResultsWe found a highly significant correlation between the degree of enophthalmos and the reduction rate of MRD (RRM, as an indicator of eyelid drooping) at 1 week after trauma (r = 0.845). Approximately 2.0 mm of enophthalmos was associated with a 30.8% reduction in MRD on the affected side as compared with the normal side. At 3 months after surgery, patients showed improved eyelid appearance, with a moderate association between enophthalmos and RRM.ConclusionWe demonstrated that the degree of enophthalmos, measured using an exophthalmometer, is associated with a change in the height of the upper eyelid. Thus, upper eyelid drooping can be used as another indicator for orbital wall fracture surgery. Compared with conventional methods, measurements of eyelid drooping are easy to perform, offering a great advantage and understanding to the patient.

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Ex- and Enophthalmos: General Aspects

Mourits

2023

Surgery in and Around the Orbit

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Exophthalmos and enophthalmos result from a discrepancy between the bony orbital cavity and its soft tissue contents. Exophthalmos arises when the orbital soft tissues enlarge or neoplasms occupy orbital space. Exophthalmos is more frequent than enophthalmos. Well-known causes of exophthalmos are Graves’ orbitopathy, orbital tumors, vascular lesions, and inflammatory diseases of the orbit. An orbital fracture causes a larger than normal orbital cavity and results—when there is no increase of the soft tissues—in an enophthalmos. Other causes of enophthalmos are i.e. silent sinus syndrome, orbital varix, and sclerosing metastasis of a mammary carcinoma.

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Parallax-free Exophthalmometry: A Comprehensive Review of the Literature on Clinical Exophthalmometry and the Introduction of the First Parallax-Free Exophthalmometer

Abstract: This meter appears to be a reliable instrument for exophthalmometry. It is the first instrument that allows for a complete parallax-free measurement.

Cited by 20 publications

References 13 publications

Axial Globe Position Measurement

Axial Globe Position Measurement

New anthropometric data for preoperative planning in orbital wall fracture treatment: the use of eyelid drooping

Ex- and Enophthalmos: General Aspects

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