Kinetic observational exophthalmometry: A simple clinical method of assessing the relative axial positions of the eyes

A simple clinical method for detecting the presence of unilateral proptosis or enophthalmos is described. It is important that in a patient with orbit al disease, a detailed ophthalmic and orbital history be taken and a carefu l clinical evaluation be performed. In the clinical assessment of such a pa tient, it is also essential to determine the presence of any asymmetry of e ye position after excluding any asymmetry in eye size or in the skeletal st ructure of the face. Observation of the patient's head from above and notin g the relative positions of the two eyes has been the traditional method in the clinical assessment of proptosis. We believe that this method of asses sment of proptosis has not been adequately described or fully exploited in the past. This paper describes an extension of the same technique. It invol ves the examiner making the observation from above while slowly moving the patient's head passively from a position of neck flexion to one of neck ext ension, and then noting which eye in a patient comes into view first. We be lieve that this kinetic technique provides an accurate method of noting any asymmetry in eye position in relation to the supraciliary ridge. It should therefore prove to be a clinically useful method in the initial assessment of a patient with suspected ocular displacement.