Table 2: The six P’s*

Table 2: The six "P’s"*

PAIN	signal inflammatory reaction and infection, orbital hemorrhage, malignant gland tumors, nasopharyngeal carcinoma
PROPTOSIS Axial displacement Superior displacement Down and medial displacement Down and lateral displacement Bilateral displacement	reflect location of a mass: -cavernous hemangioma, glioma, menin-gioma, metastases, arteriovenous malformation, lesions within the muscle cone -maxillary sinus tumors -dermoid cysts and lacrimal gland tumors -frontoethmoidal mucocoele, abscesses, osteoma, sinus carcinoma -thyroid orbitopathy, lymphoma, vasculitis, orbital inflammatory syndrome, metastatic tumors, carotid cavernous fistula, cavernous sinus thrombosis, leukemia, neuroblastoma
PROGRESSION Onset over days Onset over years	-Disorders due to orbital inflammation -dermoids, benign and malignant and meta-static tumors
PALPATION Superior nasal quadrant Superior temporal quadrant Simultaneous rise in blood pressure	-mucoceles, mucopyoceles, encephaloceles, neurofibroma, dermoids -dermoid cysts, prolapsed lacrymal gland, lacrymal gland tumor, lymphoma, orbital inflammatory syndrome -carcinoid syndrome, pheochromocytoma
PULSATION without bruit With or without bruits	-neurofibromatosis, meningoencephaloceles surgical removal of orbital roof -carotid-cavernous fistula, dural arterio-venous fistula, orbital arterovenous fistula
PERIORBITAL CHANGES Salmon-colored patchconjunctival cul de sac Lid retraction and lag Pseudo-lid retraction Vascular congestion over extraocular muscle insertion Entropion with proptosis corkscrew conjunctival vessels Vascular anomaly of lid skin S-shaped lid Anterior uveitis Eczematous lesion of the lids Ecchimoses of eyelid skin Prominent temple Edematous swelling of lower lid Optociliary shunt vessels on optic disc Frozen globe Black crusted lesion, black eschar Facial assymetry Abduction blindness	-lymphoma -Graves’disease -mass in superior fornix -Graves’disease -pseudotumor -arteriovenous fistula -lymphangioma, varix -plexiform neurofibroma -pseudotumor, sarcoid -mycosis fungoides (T-cell lymphoma) -neuroblastoma, leukemia -sphenoid wing meningioma -meningioma -meningioma -metastases, phycomyces -phycomyces -fibrous dysplasia, neurofibromatosis -optic nerve sheath meningioma

CHANDLER’S CLASSIFICATION OF ACUTE SINUSITIS

Group 1:	inflammatory edema (preseptal/periorbital cellulitis)
	reflects swelling and inflammation of the eyelids in the initial phase, can include chemosis in a more advanced disease

Group 2:	orbital cellulitis
	A result of bacterial or sterile infection, the orbit is infiltrated causing a mass or not and inducing limitation of extraocular motility and proptosis and possibly vision loss.

Group 3:	subperiostal abscess
	Caused by accumulation of purulent material within the subperiostal space introducing proptosis possibly without injection of the globe or swelling of the eyelids. The progression and onset of the disease can be an indicator of the pathogen’s virulence. The location of the mass is reflected by the angle of displacement of the ocular globe.

Group 4:	orbital abscess
	Progression of either cellulitis or subperiostal abscess in the intraconal and/or extraconal aspects of the muscle cone. Common sequelae include proptosis, inflammation, ophthalmoplegia, visual impairment and systemic toxicity.

Group 5:	cavernous sinus thrombosis
	Signaled by dramatic impairment of the central nervous system or modifications of the local inflammatory signs.