Graves disease

Eye symptoms: Eye pain, lacrimation, dry eyes, irritation, photophobia, ocular muscle weakness causing diplopia, vision loss caused by optic nerve compression

Systemic symptoms: Palpitations, anxiety, increased appetite, weight loss, insomnia, goiter, pretibial myxedema (see Hyperthyroidism)

Thyroid function tests

Sometimes CT or MRI of orbits

Carotid-cavernous sinus or dural-cavernous sinus fistula

Pulsating proptosis with an orbital bruit

Magnetic resonance angiography

Cavernous sinus thrombosis

Ophthalmoplegia, headache, ptosis, decreased visual acuity, fever

CT or MRI of brain and orbits

Congenital glaucoma

Tearing, blepharospasm, redness

Intraocular pressure measurement and fundoscopy by ophthalmologist

Orbital cellulitis

Redness, fever, pain, impaired visual acuity, impaired or painful extraocular movements

Usually unilateral

CT or MRI of orbits

Orbital tumors (eg, lymphoma, hemangioma, vascular malformations)

Decreased visual acuity, diplopia, pain

MRI or CT or orbits

Retrobulbar hemorrhage, orbital compartment syndrome

Decreased visual acuity, diplopia, pain, ophthalmoplegia, risk factors

Immediate CT orbits or treatment based on clinical findings

Spheno-orbital meningioma

Pain, headache, visual field defects, ophthalmoplegia

MRI or CT of skull base