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Differential Diagnostic Aspects of Proptosis as Seen at the In-patient Department of the University Eye Clinic of Nairobi, Kenya

1Gäckle H., 1Masinde M. S., 2Spraul C. W., 1Eisert B.,
1University of Nairobi, Department of Ophthalmology (Nairobi)
2Universität Ulm, Augenklinik und Poliklinik (Ulm)

Purpose: Many differential diagnosic aspects must be taken into consideration in patients presenting with proptosis,. Besides reduced opportunities in diagnostics and the variety of orbital diseases in Kenya, proptosis is a clinical challenge.
Method: 124 patients with proptosis were admitted and treated from March 2001 - march 2002 at the University Eye Clinic of Nairobi. A descriptive statistical analysis of all histological and microbiological results was carried out.
Results: Malignancies were found in 69 patients ( = 55.3%) orbital inflammation in 55 patients (= 44.7%). Histology of the malignancies presented 52 patients with Retinoblastoma and proptosis, 6 patients with Rhadomyosarcoma, 2 with pleomorphic adenoma, 2 lymphomas of the orbit and 1 orbital Neurofibroma. 49 (= 89.1%) patients suffered from inflammations of the orbit. Microbiolgical investigations presented 20 cases of streptococcal infection, 16 cases with Haemophilus influenza and 13 cases with Staphylococcus aureus. In 5 cases (= 9.1%) Bacillus anthracis (“Anthrax”) was found, one patient suffered from cutaneous Tuberculosis with orbital invasion.
Conclusions: Many patients came very late or in life threatening conditions to our clinic as there is a lack of eye hospitals and ophthalmologists in Kenya. Malignancies were present in 55.3% as the main cause of proptosis. Orbital inflammations showed in 11% very rare infections like cutaneous Anthrax or cutaneous Tuberculosis. These results can be considered as a hint, concerning the distribution of Proptosis of inpatients in developing countries.