Proptosis was unilateral in 40 patients & bilateral in 8 patients (Fig-1).

The most common etiology of proptosis in the present study was orbital cellulitis (14 cases); among them, two had bilateral proptosis. The neoplasm was the second most common cause of proptosis, affecting 13 eyes of 11 patients. 2 patients had bilateral proptosis. Thyroid ophthalmopathy was found in 8eyes of 5 patients, of which three patients had bilateral proptosis. In 3 patients, the cause of proptosis was pseudotumour orbit. Other causes of proptosis were mucormycosis in 1 patient, vascular lesions in 3 patients & mucocele in 2 patients. Trauma was responsible for 2 cases of unilateral proptosis. In 4 patients etiology of unilateral proptosis was congenital lesions. In 1 patient, sarcoidosis was the cause of bilateral proptosis. The diagnosis was not known in 2 patients with unilateral proptosis. [Table-2] 

It was axial in 28 cases & eccentric (nonaxial) in 20 cases [Table-3, Figure-2].

The most common symptoms were protrusion of the eye (48 cases) followed by eye pain (34 cases) & headache (30 cases). Other symptoms are diminished vision, diplopia, diminished motility, epiphora, chemosis & proptosis. [Table-4]

Patients with orbital cellulitis presented with proptosis, restricted extraocular motility, conjunctival congestion. In some patients with orbital cellulitis, relative afferent pupillary defect, optic nerve, edema & pallor was seen. Patients of orbital cellulitis were managed with IV broad-spectrum antibiotics for 7-10 days, nonsteroidal anti-inflammatory drugs, topical antibiotics and topical lubricating drops. In all patients with orbital cellulitis, proptosis subsided, and in 12 patients, visual improvement occurred after treatment. In 2 patients, there was no visual improvement due to optic nerve involvement. The second most common cause of proptosis was the orbital tumour. Most were orbital malignancies viz, retinoblastoma (1 patient), squamous cell carcinoma (3 patients), lymphoma (1 patient), adenocarcinoma of the lacrimal gland (1 patient). Some were benign tumours, meningioma (1 patient), haemangioma (1patient), lymphangioma (1 patient), optic nerve gliomas, pleomorphic adenoma of lacrimal glands. These orbital tumours were diagnosed clinically and with orbital imaging like CT/MRI.

signs like orbital fat expansion & fusiform rectus muscle enlargement with sparing of muscle tendons. Lab investigations like T3, free T4 & TSH levels were also done in all thyroid eye disease patients& for the control thyroid hormone levels, patients were referred to the medical department. For mild disease, lubricant eye drops were given for an ocular surface disease. In 3 patients, the cause of proptosis was orbital pseudotumor, where no known etiology was found.

In 3 patients,the cause of proptosis was orbital pseudotumor,where no known etiology was found. Patients presented with myositis, pain, periorbital edema, ptosis, chemosis, proptosis & decreased ocular motility. The diagnosis was made based on clinical findings, orbital imaging with enhancing lesions, rectus muscle enlargement with tendon involvement and scleral enhancement with prompt response to systemic steroid administration. In 2 patients, trauma was found responsible for the proptosis. Patients presented with pain, proptosis, diminished vision, reduced ocular motility, increased intraocular pressure and subconjunctival hemorrhage. Patients were managed with lateral canthotomy with inferior and superior cantholysis. Congenital lesions were seen in 4 patients, vascular lesions were found in 3 eyes of 3 patients. In 2 patients, mucocele and one, sarcoidosis was responsible for proptosis. In 2 cases of unilateral proptosis, the diagnosis was not confirmed. [Figure. 3& 4]

Fig-1: Unilateral (40) and Bilateral proptosis (8)

Fig-2: Eccentric (20) and Axial proptosis (28)

sexes [10]. Zaidi SH et al. showed a female preponderance [11]. Unilateral proptosis was more common in our study, as was found by S. Guthoupe J.D. and Hochman M [4]. The axial direction of proptosis was noticed maximally in this study which is similar to the observation done by Loganathan M, Radhakrishnan M et al. [8]. Orbital cellulitis was the most common cause of proptosis in our study; similar results were obtained in a study done by Majekodunmi S et al. in Nigeria  & a study done by Sultana A et al. in South India [7,12]. In a study done by Masud et al. in Peshawar, infection was the number three cause of proptosis (2). The orbital tumour is the second most common cause of proptosis in this study. Khan et al., in their research, found orbital tumours as the cause of proptosis in two-thirds of their patients [13]. also, Ogbeide and Theophilus in Benin city reported that tumour was the most common cause of proptosis. [14]. Thyroid ophthalmopathy was the third most common cause of proptosis found in our study, which showed the frequent occurrence of bilateral proptosis in thyroid ophthalmopathy, which is consistent with the findings by Sabharwal et al. [15]. In the present study, trauma due to a road traffic accident presenting as orbital hemorrhage was an important cause of proptosis which was similar to the results by Ogbeide and Theophilus in Benin city Nigeria (14). Other reasons for proptosis in our study included Vascular lesions, Congenital lesions, Mucormycosis, Sarcoidosis etc. In 2 cases, the diagnosis was not confirmed.