Exploring the Etiologies of Acquired Unilateral Proptosis: A Literature Review with Case Presentations

Abstract Acquired unilateral proptosis is a clinically significant condition with diverse etiologies, including trauma, inflammation or infection, tumors, and hemodynamic complications. This study aimed to improve recognition by integrating a literature review with illustrative case reports. Four representative cases were described, covering orbital infection, traumatic hematoma, carotid–cavernous fistula, and metastatic tumor. A focused literature review of publications from 2020 to 2024 was conducted, identifying 338 relevant studies, of which 171 met the inclusion criteria. Among the 171 eligible studies analyzed, tumors were the most frequent cause (93/171, 54.4%), followed by hemodynamic disorders (24/171, 14.0%), thyroid-related ophthalmopathy (13/171, 7.6%), infection, and inflammation. In tumors, metastatic tumor (n = 10) represented the most common subtype, followed by sarcoma (n = 9), retinoblastoma (n = 7), and lymphoma (n = 7). The four clinical cases aligned with these categories and illustrated a spectrum of outcomes—from irreversible vision loss in infection to visual preservation through timely endovascular intervention. This study provided a more detailed understanding of the diverse etiologies of acquired unilateral proptosis, suggesting the necessity of a multidisciplinary approach. Integrating these findings into clinical practice is expected to enhance early recognition, optimize treatment strategies, and ultimately improve patient outcomes.