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What causes it?
Proptosis, also called exophthalmos, is forward displacement of the eye in the orbit. It is caused by swelling of the soft tissues or bones of the orbit.

The common causes are inflammation, infection and tumor. In this child, the lesion is a malignant tumor—a rhabdomyosarcoma.

When the proptosis is bilateral, the most common cause is Graves' disease, which causes inflammatory swelling of extraocular muscles and orbital fat.

What to do?
Refer for ophthalmologic evaluation with an urgency dependent on the rapidity of onset.

Unilateral proptosis is always a greater concern than bilateral proptosis because of the fear of malignancy.

In young children, orbital tumors can be very aggressive; early treatment may be life-saving.

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