Identify the instrument shown in the picture below ?
A. Luedde’s exophthalmometer.
B. Hertel’s exophthalmometer.
C. Hess screen.
D. Maddox rod test.
Ans:B. Hertel’s exophthalmometer.
- It is an instrument used for measuring the degree of forward displacement of the eye in exophthalmos.
- The device allows measurement of the forward distance of the lateral orbital rim to the front of the cornea.
- Exophthalmometers can also identify enophthalmos (retraction of the eye into the orbit), a sign of blow-out fracture or certain neoplasms.
- There are several types of exophthalmometers, Hertel and Luedde measure the distance of the corneal apex from the level of the lateral orbital rim while Naugle measures the relative difference between each eye:
- Hertel exophthalmometer: measurement is taken from the lateral orbital rim to the corneal apex.
- If a patient presents with an orbital fracture or after lateral orbitotomy, the use of Hertel exophthalmometer may be complicated because the lateral orbital rim serves as a reference point for this instrument.
- Consideration should be given to the use of the Naugle exophthalmometer in these cases.
- Naugle exophthalmometeruses fixation points slightly above and below the superior and inferior orbital rims (cheek bones and forehead).
- Naugle exophthalmometer measures the difference in proptosis between the two eyes rather than absolute measure with the Hertel method.
- Luedde exophthalmometer fixes on lateral orbital wall and uses a transparent ruler to measure the amount of protrusion.
- The normal range is 12–21 mm.
- A difference greater than 2 mm between the eyes is significant.