Disorders of he orbit 29 Pee 22 Tp fail pops wy cent by a rao sue occupying Tso; tp right, betom eft an ettom right: a ater pe ‘caring lesion ipl ona eccentric propo th coment of the glade sy fom the sito the sion Figure 23 Mowsurenent of propos with «Hertel eptaiometer placing the rule over the bridge of the nose. The size of the vertical apertures should also be noted. EXCLUSION OF PSEUDOPROPTOSIS ‘The three main causes of pseudoproptosis are (1) very large ipsilateral globe, (2) facial asymmetry and (3) contralateral enophthalmos (Figure 25). The last is frequently a subtle clinical sign which may be mistaken Figure 24 Messiremont of proploss with « plas nie for either ipsllateral ptosis or contralateral proptosis. The following are the main mechanisms which may cause enophthalmes: 1. Microphthalmos (small globe) 2. Structural abnormalities of the orbital bones, such a5 blow-out fracture of the orbital floor and congenital defects, Two causes of the latter are maxillary hypoplasia and absence of the greater wing of the sphenoid bone which may occur in neurofibromatosis type 1 3, Atrophy or clcatrization of orbital contents. Causes: {include postirradiation atrophy, postinflammatory céeatrization of extraocular muscles and cicatrizing ‘metastatic carcinoma. 4, Postsurgical shortening of extraocular muscles follow ing excessive resections.