Palpation

Palpation around the globe may disclose the presence of a mass in the anterior orbit, especially if the lacrimal gland is enlarged. Increased resistance to retrodisplacement of the globe is a nonspecific abnormality that may result either from a retrobulbar tumor or from diffuse inflammation such as that seen in TED. The physician should also palpate regional lymph nodes.

The differential diagnosis for a palpable mass in the superonasal quadrant may include mucocele, mucopyocele, encephalocele, neurofibroma, dermoid cyst, rhabdomyosarcoma, lymphoma, or amyloid. A palpable mass in the superotemporal quadrant may be a prolapsed lacrimal gland, a dermoid cyst, a lacrimal gland tumor, lymphoma, or NSOI. A lesion behind the equator of the globe is usually not palpable.

Pulsation of the eye is caused by transmission of the vascular pulse through the orbit. This may result from either abnormal vascular flow or transmission of normal intracranial pulsations through a bony defect in the orbital walls. Abnormal vascular flow may be caused by arteriovenous communications, such as carotid-cavernous fistulas. Defects in the bony orbital walls may result from sinus mucoceles, surgical removal of bone, trauma, or developmental abnormalities, including encephalocele, meningocele, or sphenoid wing dysplasia (associated with neurofibromatosis).

Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.