Normal Range of Exophthalmometry values in Pakistani Population – A multi-center cross-sectional national study
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Abstract Background. Measurements of ocular protrusion and inter-orbital distance has not been measured in Pakistan at national level before. The current study comprising 7002 participants is the largest in the world so far.The objective was to determine the normal exophthalmometry value (EV) and to calculate mean inter-orbital distance (IOD) for Pakistani population. Methods. It was a cross-sectional study conducted from July 2022 to June 2023. A total of 12 centers from seven cities across Pakistan conducted this survey. The participants were the patients attending the outpatient department of the hospitals. A single examiner in each center recorded the EV and IOD reading using Hertel’s Exophthalmometer. Results. The participants had a mean age of 38.2 ± 17.5 years. The average exophthalmometry measurements for the right and left eyes were 16.5 ± 2.71 mm and 16.6 ± 2.77 mm, respectively, while the mean inter-orbital distance (IOD) was 105.3 ± 10.20 mm. Females had significantly higher EV compared to males (p < 0.001), with no notable gender difference in IOD (p = 0.080). Adults had the highest EV values, while children had the lowest, and IOD was widest among teenagers and adults but decreased in older individuals. Regionally, Khyber Pakhtunkhwa recorded the widest IOD (114.3 mm), while Azad Jammu & Kashmir had the highest EV (20 mm). Descriptive statistics were calculated for continuous variables and frequency distributions were computed for categorical variables. For inferential statistics, a paired t-test was applied to assess the difference between EVOD and EVOS. An independent t-test was used to examine gender-based differences. Additionally, Pearson correlation analysis was conducted to evaluate the relationships between IOD and EVOS, as well as between EVOD and EVOS. A significance level of 5% (p < 0.05) was maintained throughout all statistical tests. Conclusion. The study provides detailed data on EV and IOD in Pakistani population for the first time. This study provides baseline data for future research on the subject as well for measurement of abnormal protrusions due to different diseases Similarly, normal IOD of Pakistani population determined in this study will provide a baseline for various maxillofacial and oculoplastic surgical procedures.
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Measurements of ocular protrusion and inter-orbital distance has not been measured in Pakistan at national level before. The current study comprising 7002 participants is the largest in the world so far.The objective was to determine the normal exophthalmometry value (EV) and to calculate mean inter-orbital distance (IOD) for Pakistani population. Methods. It was a cross-sectional study conducted from July 2022 to June 2023. A total of 12 centers from seven cities across Pakistan conducted this survey. The participants were the patients attending the outpatient department of the hospitals. A single examiner in each center recorded the EV and IOD reading using Hertel’s Exophthalmometer. Results. The participants had a mean age of 38.2 ± 17.5 years. The average exophthalmometry measurements for the right and left eyes were 16.5 ± 2.71 mm and 16.6 ± 2.77 mm, respectively, while the mean inter-orbital distance (IOD) was 105.3 ± 10.20 mm. Females had significantly higher EV compared to males (p < 0.001), with no notable gender difference in IOD (p = 0.080). Adults had the highest EV values, while children had the lowest, and IOD was widest among teenagers and adults but decreased in older individuals. Regionally, Khyber Pakhtunkhwa recorded the widest IOD (114.3 mm), while Azad Jammu & Kashmir had the highest EV (20 mm). Descriptive statistics were calculated for continuous variables and frequency distributions were computed for categorical variables. For inferential statistics, a paired t-test was applied to assess the difference between EVOD and EVOS. An independent t-test was used to examine gender-based differences. Additionally, Pearson correlation analysis was conducted to evaluate the relationships between IOD and EVOS, as well as between EVOD and EVOS. A significance level of 5% (p < 0.05) was maintained throughout all statistical tests. Conclusion. The study provides detailed data on EV and IOD in Pakistani population for the first time. This study provides baseline data for future research on the subject as well for measurement of abnormal protrusions due to different diseases Similarly, normal IOD of Pakistani population determined in this study will provide a baseline for various maxillofacial and oculoplastic surgical procedures. Exophthalmometry value inter-orbital distance Proptosis Exophthalmos Figures Figure 1 Figure 2 Figure 3 Figure 4 Background The bony skeleton that hosts the eyeball in human being is known as orbit. Orbit is roughly a V-shaped cavity with medial walls on both sides being parallel to each other while the lateral walls are almost at right angle to each other. The eyeballs are not totally immersed in the bony orbit and part of these lie outside which actually defines the extent of our visual field. The normal amount of this ocular protrusion as measured from the lateral orbital rim to the corneal apex is called as exophthalmometry value (EV). This measurement can be made by a pair of simple millimeter rulers or by a specially designed instrument known as exophthalmometer and the process is called as exophthalmometry. Exophthalmometer simultaneously measures distance between both the outer orbital rims, called as inter-orbital distance (IOD). Both EV and IOD varies with age, gender, race and geography. Various studies have been conducted in different countries to determine these values 1 – 7 , but such a study at national level has never been carried out in Pakistan before. The current study conducted all over Pakistan, comprising 7002 participants is the largest in the world so far. The objective was to determine the normal exophthalmometry value (EV) and to calculate mean inter-orbital distance (IOD) for Pakistani population. This study will serve as reference point for future research on the subject as well for measurement of abnormal protrusions (exophthalmos, proptosis) due to different diseases like thyroid eye disease, orbital tumors, congenital anomalies etc. Similarly, normal IOD of Pakistani population determined in this study will provide a baseline for various maxillofacial and oculoplastic surgical procedures. Methodology Design, Settings and Participants It was a cross-sectional study conducted throughout Pakistan from July 2022 to June 2023. A total of 12 centers from seven cities across Pakistan conducted this survey in which a total of 7,002 participants volunteered to take part. These included Bahawalpur (one center), Lahore (three centers) and Rawalpindi (two centers) from Punjab province, Karachi (one center) from Sindh province, Mirpur (one center) from the region of Kashmir (AJK), Peshawar (two centers) from Khyber Pakhtunkhwa (KpK) province and Quetta (two centers) from Baluchistan province. The study conforms to the ethical principles outlined in the Declaration of Helsinki for medical research involving human subjects. Sampling technique The participants were the patients attending the outpatient department of the hospitals who were properly informed about the study and its protocol and who consented to take part in the study. A single examiner in each center recorded the EV and IOD reading using Hertel’s Exophthalmometer. (It may be noted that all qualified ophthalmologists are trained in performing Hertel Exophthalmometry). Inclusion criteria included all healthy individuals 9 years and above, while exclusion criteria were c onditions causing proptosis like thyroid eye disease, orbital, paraorbital masses and inflammations, obvious squint, abnormal orbit development like Crouzen Syndrome, unilateral or bilateral phthisis bulbi or microophthalmia, unilateral or bilateral buphthalmos or keratoconus, sunken eyes due to dehydration, malnutrition, etc., and myopia or hypermetropia of more than 6 diopters. Data Collection The designated ophthalmologist in each study center performed Hertel exophthalmometry on all outpatients meeting laid down criteria. The basic demographic profile for each participant was documented. It included age, gender and district of domicile. The basic clinical examination was conducted for all the participants of the study including visual acuity, intra-ocular pressure, anterior segment examination with slit-lamp and posterior segment examination. The Hertel reading was entered into the proforma that included EV reading for each eye along with inter-orbital distance. Statistics Descriptive statistics were calculated for continuous variables such as Age, EVOD, EVOS, and IOD, including measures like mean, standard deviation, and standard error. For categorical variables such as gender, frequency distributions were computed. For inferential statistics, a paired t-test was applied to assess the difference between EVOD and EVOS. An independent t-test was used to examine gender-based differences. Additionally, Pearson correlation analysis was conducted to evaluate the relationships between IOD and EVOS, as well as between EVOD and EVOS. A significance level of 5% (p < 0.05) was maintained throughout all statistical tests. Results This study analyzed data from 7002 participants across all provinces of Pakistan, with a mean age of 38.2 ± 17.5 years, revealing significant variations by region, gender, and age. The average exophthalmometry measurements for the right eye (EV OD) and left eye (EV OS) were 16.5 ± 2.71 mm and 16.6 ± 2.77 mm, respectively, while the mean inter-orbital distance (IOD) was 105.3 ± 10.20 mm. The EV asymmetry of 2 mm or more between the two eyes was found in 8.51% of the participants. Females had significantly higher EV OD and EV OS values compared to males (p < 0.001), with no notable gender difference in IOD (p = 0.080). Age-based trends showed that adults had the highest EV OD and EV OS values, while children had the lowest, and IOD was widest among teenagers and adults but decreased in older individuals. Regionally, Khyber Pakhtunkhwa recorded the widest IOD (114.3 mm), while Azad Jammu & Kashmir had the highest EV OD and EV OS values (20 mm). Pearson’s correlation analysis showed weak positive relationships between age and EV OD (r = 0.048, p < 0.001) and EV OS (r = 0.056, p < 0.001), and a weak negative relationship between age and IOD (r = -0.123, p < 0.001). These findings provide comprehensive normative data on exophthalmometry measurements and inter-orbital distance for the Pakistani population, emphasizing demographic variations. Table 1 summarizes the age-related demographic characteristics of 7,002 participants from a multi-center study across Pakistan, including Punjab, Sindh, Khyber Pakhtunkhwa (KPK), Baluchistan, and Azad Jammu & Kashmir (AJK). The data, stratified by gender, includes the total number of participants (N), mean ± standard deviation, median ± interquartile range, and age range. Punjab contributed the highest participants (4,364). AJK participants had the oldest average age (43.9 years). Males generally had a slightly younger average age compared to females across most regions, with Baluchistan showing an exception where females were older on average. Table 1 Demographic characteristics (age) across different regions of Pakistan Demographic regions N Age: Mean ± SD(Median ± IQR) Age Range Pakistan Total 7002 38.2 ± 17.5(35.0 ± 27) 9-100 Male 4424 37.8 ± 17.4(35.0 ± 28) 10–100 Female 2578 38.9 ± 17.7(38.0 ± 27) 9-100 Punjab Total 4364 38.4 ± 17.5(35 ± 29) 10–100 Male 3089 38.0 ± 17.5(35 ± 29) 10–100 Female 1275 39.4 ± 17.6(40 ± 29) 10–100 Sindh Total 1111 39.5 ± 19.2(37.0 ± 29) 10–93 Male 556 40.0 ± 19.2(38.0 ± 29.3) 10–91 Female 555 39.0 ± 19.2(37.0 ± 28.5) 9–93 KPK Total 863 33.8 ± 15.7(29.0 ± 24) 10–100 Male 471 33.4 ± 14.8(29.0 ± 23) 10–80 Female 392 34.3 ± 16.6(30.0 ± 27) 10–100 Baluchistan Total 158 27.9 ± 10.7(25.5 ± 12) 10–67 Male 110 26.3 ± 7.83(25.0 ± 10.8) 10–57 Female 48 31.5 ± 14.94(26.5 ± 28.3) 14–67 AJK Total 506 43.9 ± 14.7(43.0 ± 23) 21–75 Male 198 44.7 ± 14.4(43.0 ± 21.5) 21–75 Female 308 43.4 ± 14.9(43.0 ± 23.3) 21–75 Table 2 presents normative data for exophthalmometry values of the right eye (EV OD), left eye (EV OS), and inter-orbital distance (IOD) across Pakistan and its regions, including Punjab, Sindh, Khyber Pakhtunkhwa (KPK), Baluchistan, and Azad Jammu & Kashmir (AJK). The data includes the number of participants (N), mean ± standard deviation (SD), median ± interquartile range (IQR), standard error (SE), range, statistical values, 95% confidence intervals (lower and upper bounds), and p-values. Nationally, the mean EV OD and EV OS are 16.5 mm and 16.6 mm, respectively, with a mean IOD of 105.3 mm. Regional differences are evident, with KPK showing the highest mean IOD (114.3 mm), and AJK demonstrating the highest mean EV OD and EV OS values (20 mm for both eyes). Baluchistan has the lowest mean values for EV OD (15 mm) and EV OS (14.9 mm). All measurements across regions show statistically significant variations (p < 0.001).This table highlights the regional variability and provides a comprehensive reference for exophthalmometry and inter-orbital distance norms in Pakistan. Table 2 Normative Data for Exophthalmometry value (EV) & Inter-Orbital Distance (IOD) 95% CI Region N Mean ± SD(Median ± IQR) Range Statistic Lower Upper P value Pakistan EV OD 7002 16.5 ± 2.71(17 ± 3) 0.0324 8–29 508 16.4 16.5 < .001 EV OS 7002 16.6 ± 2.77(17 ± 3) 0.0331 8–29 501 16.5 16.6 < .001 IOD 6524 105.3 ± 10.20(107.0 ± 18) 0.1263 80–123 834 105.1 `105.5 < .001 Punjab EV OD 4364 16 ± 2.62(16 + 4.00) 0.0396 8–26 399 16.1 16.2 < .001 EV OS 4364 16.1 ± 2.67(16 ± 4.00) 0.0405 8–26 700 105.9 106.5 < .001 IOD 3984 106.2 ± 9.58(110 ± 17.00) 0.1517 80–123 405 16.0 16.1 < .001 Sindh EV OD 1111 16.6 ± 2.21(95 ± 15) 0.0663 8–22 250 16.4 16.7 < .001 EV OS 1111 16.5 ± 2.20(17 ± 2) 0.0661 8–22 250 16.4 16.6 < .001 IOD 1111 97.0 ± 9.49(17 ± 3) 0.2847 80–120 341 96.5 97.6 < .001 KPK EV OD 863 16.8 ± 2.67 (16 ± 3) 0.0910 10–29 184 16.6 16.9 < .001 EV OS 863 17.1 ± 2.91 (17 ± 4) 0.0990 10–29 172 16.9 17.3 < .001 IOD 863 114.3 ± 6.40 (115 ± 10) 0.2178 85–123 525 113.9 114.8 < .001 Baluchistan EV OD 158 15 ± 1.85 (15 ± 2) 0.147 9–23 157.0 14.7 15.3 < .001 EV OS 158 14.9 ± 1.86 (15 ± 2) 0.148 9-23.5 157.0 14.6 15.2 < .001 IOD 60 113.4 ± 6.07 (115 ± 10) 0.784 100–120 59.0 111.8 115.0 < .001 AJK EV OD 506 20 ± 1.99 (20 ± 4) 0.0886 17–23 226 19.8 20.2 < .001 EV OS 506 20 ± 1.85 (20 ± 2) 0.0820 10–29 244 19.9 20.2 < .001 IOD 506 99.8 ± 3.79 (99 ± 6) 0.1687 94–106 592 99.4 100.1 < .001 Table 3 provides normative data for exophthalmometry measurements (EV OD and EV OS) and inter-orbital distance (IOD) categorized by age groups: children, teenagers, adults, and elders. The table includes the number of participants (N), percentage (%), mean ± standard deviation (SD), median ± interquartile range (IQR), standard error (SE), range, and 95% confidence intervals (lower and upper bounds). Children exhibit the lowest mean EV OD (14.4 mm) and EV OS (14.7 mm), while adults have the highest mean values (16.7 mm and 16.8 mm, respectively). IOD is widest among teenagers (mean 105.8 mm) and adults (mean 105.6 mm), while elders show a significant reduction (mean 101.2 mm).The interquartile range and standard deviation indicate greater variability in children compared to other age groups. This table provides valuable insights into age-related changes in ocular measurements, serving as a reference for clinical and research applications. Table 3 Age-Based Normative Data for Exophthalmometry Values and Inter-Orbital Distance 95% Confidence Interval EVOD N (%) Mean ± SD(Median ± IQR) SE Range Lower Upper Children (9-15years) 110 14.4 ± 3.15(14.0 ± 5.00) 0.3003 8.00–29.0 13.8 15.0 Teenagers (16-19years) 865 15.7 ± 2.51(15.0 ± 3.00) 0.0853 9.00–25.0 15.5 15.8 Adults (20–69 years) 5632 16.7 ± 2.67(17.0 ± 3.00) 0.0356 8.00–21.0 16.6 16.7 Elders (70-100years) 395 16.0 ± 2.98(16.0 ± 4.00) 0.1498 10.00–23.0 15.7 16.3 EVOS Children (9-15years) 110 14.7 ± 3.29(14.5 ± 5.00) 0.3136 8.00–21.0 14.1 15.3 Teenagers (16-19years) 865 15.7 ± 2.53(15.0 ± 3.00) 0.0860 9.00–25.0 15.5 15.8 Adults (20–69 years) 5632 16.8 ± 2.73(17.0 ± 4.00) 0.0363 8.00–29.0 16.7 16.8 Elders (70-100years) 395 16.2 ± 3.01(17.0 ± 4.00) 0.1515 9.00–23.0 15.9 16.5 IOD Children(9-15years) 106 103.0 ± 12.55(107.5 ± 23.75) 1.2188 80–123 100.6 105.4 Teenagers(16-19years) 748 105.8 ± 11.24(110.0 ± 19.00) 0.4108 80–123 105.0 106.6 Adults (20–69 years) 5280 105.6 ± 9.92(107.0 ± 18.00) 0.1365 80–123 105.3 105.8 Elders(70-100years) 390 101.2 ± 10.25(99.0 ± 16.00) 0.5189 80–123 100.2 102.3 Table 4 Gender Differences in Exophthalmometry Measurements and Inter-Orbital Distance Group N Mean SE t P EV OD Male 4424 16.3 ± 2.71 0.0407 -8.78 < 0.001 Female 2578 16.8 ± 2.68 0.0528 EV OS Male 4424 16.3 ± 2.77 0.0417 -9.35 < 0.001 Female 2578 17.0 ± 2.70 0.0532 IOD Male 4170 105.2 ± 10.15 0.1571 -1.41 < 0.080 Female 2354 105.5 ± 10.30 0.2123 EVOD vs EVOS EVOD 7002 16.5 ± 2.71 0.0324 -8.07 < .001 EVOS 7002 16.6 ± 2.77 0.0331 Table 4 compares exophthalmometry measurements (EV OD and EV OS) and inter-orbital distance (IOD) between males and females, as well as a paired comparison between EV OD and EV OS across the total population. The analysis includes the number of participants (N), mean ± standard deviation (SD), standard error (SE), t-statistic, and p-value. Females have significantly higher mean values for EV OD (16.8 mm vs. 16.3 mm, p < 0.001) and EV OS (17.0 mm vs. 16.3 mm, p < 0.001) compared to males. IOD is similar between males (105.2 mm) and females (105.5 mm), with no statistically significant difference (p = 0.080). Paired comparison of EV OD and EV OS across the entire cohort shows a statistically significant difference, with EV OS being slightly higher on average (p < 0.001). These findings highlight gender-based differences in ocular measurements, with females generally exhibiting larger exophthalmometry values. Table 5 Pearson’s Correlation between age and ocular measurements Pearson's r p Age EV OD 0.048 < .001 EV OS 0.056 < .001 IOD -0.123 < .001 This table presents Pearson’s correlation coefficients (r) and p-values for the relationships between age and ocular measurements, including exophthalmometry values of the right eye (EV OD), left eye (EV OS), and inter-orbital distance (IOD). A weak positive correlation exists between age and EV OD (r = 0.048, p < 0.001) and EV OS (r = 0.056, p < 0.001), indicating slight increases in these values with age. Conversely, age is weakly negatively correlated with IOD (r = -0.123, p < 0.001), suggesting a gradual decrease in inter-orbital distance as age increases. While statistically significant, these correlations indicate a minimal effect of age on ocular measurements. Table 6 Correlation between Inter-Orbital Distance and Exophthalmometer Values Variables Pearson’s r p Value 95% CI Lower 95% CI Upper IOD – EV OD 0.326 < .001 0.308 1.000 IOD – EV OS 0.341 < .001 0.322 1.000 The analysis shows a statistically significant positive correlation between inter-orbital distance and the exophthalmometer value of the right and left eyes. This suggests that greater inter-orbital distance is associated with greater forward positioning of the left eye, as measured by exophthalmometry. The 95% confidence interval for the correlation coefficient (0.308 to 1.000) indicates a moderate-to-strong relationship and confirms the consistency of this positive association. Given the one-tailed test used, these findings support the directional hypothesis that IOD is positively associated with eye protrusion. Figure 2 compares exophthalmometry measurements (EV OD and EV OS) and inter-orbital distance (IOD) between genders and includes a paired analysis of EV OD and EV OS for the total population. Females have significantly higher mean values for EV OD (16.8 mm vs. 16.3 mm, p < 0.001) and EV OS (17.0 mm vs. 16.3 mm, p < 0.001) than males. No significant difference was observed in IOD between males (105.2 mm) and females (105.5 mm, p = 0.080). A paired analysis revealed a significant difference between EV OD and EV OS, with EV OS being slightly higher (p < 0.001). These results underscore gender-based differences in exophthalmometry values, with females exhibiting larger measurements. Figure 3 presents the Pearson's correlation coefficients (r) and their corresponding p-values, indicating the relationships between age and ocular measurements. A weak positive correlation was observed between age and Exophthalmometer Ocular Dexter (EV OD, r = 0.048, p < .001) and between age and Exophthalmometer Ocular Sinister (EV OS, r = 0.056, p < .001). In contrast, a weak negative correlation was found between age and Inter-Orbital Distances (IOD, r = -0.123, p < .001), all of which are statistically significant. Discussion With 7002 participants, this is the largest study on exophthalmometry values (EV) and interorbital distance measurements published in English literature so far. The study provides detailed data on exophthalmometry values and inter-orbital distance in Pakistani population for the first time. With overall mean for EV 16.52, EV range was 8–29. The mean EV were 16.5mm and 16.6mm in right and left eye respectively. The mean EV for males and females were 16.29 mm and 16.90 mm respectively. The mean inter-orbital distance (IOD) was found to be 105.3 mm with a range of 80–123. The mean IOD for male and female were 105.2 and 105.5 respectively We used Hertel’s Exophthalmometer for measuring EVs and IOD. While various other techniques ranging from instrumental to radiological had been used to measure this value in different studies, the use of Hertel’s exophthalmometer remains the most favored 1 , 2 . Incorrect measurements might occur if Hertel footplates are not correctly positioned on the lateral orbital rim or the device is not aligned horizontally. This base measurement has great impact on final measurement obtained 3 , 4 . It has been reported that every 2 mm medial displacement of footplate results in 3.8 mm under-reading of proptosis 3 . All the observers who conducted exophthalmometry in this study were fully trained and qualified ophthalmologists. Table 7 A comparison of EVs & IOD from different studies conducted across the globe SN Year Place of Study Sample size Mean Exophthalmometry values (EV) Interorbital distance (IOD) Mean Range Mean Range 01 2008 Turkey 3 2477 13 5–21 02 2009 Sri Lanka 5 1341 15.82 10–21 03 2014 Nigeria 6 1020 15 10–22 04 2015 Chinese-Han 7 2010 15 10–22 108 ± 6.3 87–122 05 2019 Chinese-HK 8 1485 15 9–21 06 2019 Iran (Meta-analysis of four studies) 9 3696 16.3 12–20 07 2022 Indian (North) 10 1000 15 8–22 100.78 ± 5.63 84–120 08 2025 Current Study 7002 16.52 8–29 105.3 ± 10.20 80–123 Table 8 Current study-Summary of Results Exophthalmometry values - EV (N = 7004) Inter Orbital Distance-IOD (N = 6524) Overall mean Mean for males Mean for females Mean for Right eye Mean for left eye EV Range Overall mean Mean for male Mean for female IOD Range 16.52 16.297 16.909 16.5 ± 2.71 16.6 ± 2.77 8–29 105.3 ± 10.20 105.2 ± 10.15 105.5 ± 10.30 80–123 There are well established data in the literature in terms of upper and lower limits of normal eye protrusions for various populations 1 , 11 , 12 . In most of these studies, upper limit of ocular protrusion is accepted to be 21 mm, however, this cannot be considered as universal because of race and geography, and upper limit for one race may not be the same for the others. The EVs in Pakistani population was found to be in the range of 8–29. The upper limit of 29 is higher than most of the large studies published 3 , 5 – 10 . (Only studies over 1000 participants were included for comparison (Table 7 ). The mean EV ranged from minimum of 13 in a Turkish study 3 to maximum of 16.52 in our study. The effect of age was also studied in detail. Children showed the lowest mean EV OD (14.4 mm) and EV OS (14.7 mm), while adults had the highest mean values (16.7 mm and 16.8 mm, respectively). The elderly group (> 70 years) displayed a reduction in these values. Pearson’s correlation showed a weak positive relation between age and EVs. While statistically significant, these correlations indicate a minimal effect of age on ocular measurements in our study. This is consistent with observation of Mourits et al 13 who reported that age has no effect on proptosis and proposed that a larger sample size might reveal a small age effect. However there are other conflicting reports regarding the effect of age on the exophthalmometry values. Beden et al 14 concluded that the EV decreases significantly after third decade. Kashkouli et al 15 showed that age had a positive correlation in children and teenagers whereas a negative correlation was observed in adults. Wu et al 7 in his study found that the EV was lowest in children and highest in adults. Similarly, Jarusaitiene et al 16 revealed the EV increases with the growing age. However, studies by Chan, Cheung, Karti and Tsiogka et al suggested that age had a negative correlation 5 , 8 , 17 , 18 . We observed that the highest values were recorded in adults followed by teenagers and the lower values were observed in children and the elderly group. The ocular protrusion increases from childhood to adulthood because of facial modeling and/or increase in orbital soft tissue volume 15 . However a recent study has for the first time looked into comprehensive understanding of all periorbital components, including upper and lower orbital fat, orbital cavity volume, globe volume, and globe position, in the context of aging. This study from Thailand 19 has shown that there was no statistically significant correlation between age and the volume of anterior, posterior, or total upper orbital fat. Total orbital fat volume was found to increase in relation to aging with statistical significance. On the other hand orbital cavity volume was observed to increase in relation to aging with statistical significance. Interestingly globe volume exhibited a significant decrease with age. There was a decrease in the anteroposterior dimension of globe position with age, indicating an enophthalmic tendency. However, there was no change in globe position in the vertical plane. The association between gender and EV shows wide variation across different studies. Number of studies 1 , 5 , 8 , 13 reported significantly higher values in males than in females. Kashkouli et al 15 and Wu et al 7 did not find a statistically significant correlation between gender and EV in their study. A recent Greek study 18 showing a statistically significant negative correlation between EV and female gender 20 attributed the higher male EV to the larger body structure. Males in general are taller, heavier with larger hip and waist circumference, and are likely to have higher EV 20 . Similarly a recent study based on MRI measurements showed that males exhibited larger volumes of total orbital fat than females 19 . However in total contrast, our study which is the largest so far with 2578 female participants, has shown statistically significant gender-based differences in ocular measurements, with females exhibiting larger exophthalmometry values. The effect of laterality on EV has been shown to be variable. Some studies 6 , 21 , 22 have reported a higher value in the left eye. Results of meta-analysis on 3,696 normal Iranians 9 showed that the mean eye protrusion was not different between the right and left eyes. Some earlier studies 1 , 23 also reported no significant difference. Higher ocular protrusion on the right side has also been reported 24 . Paired comparison of EV OD and EV OS in our study across the entire cohort shows a statistically significant difference, with EV OS being slightly higher on average (p < 0.001). Apparently there is no reason accounting for this difference. A parallax error due to an apparent change in the position of the eye when the examiner changes position might account for the difference. Regional differences in the EV have also been reported. In the current study, regional differences are evident with AJK (Northern region) demonstrating the highest mean EV OD and EV OS values (20 mm for both eyes) and Baluchistan (southwestern region) has the lowest mean values for EV OD (15 mm) and EV OS (14.9 mm). All measurements across regions show statistically significant variations (p < 0.001). A recent north Indian study has also shown similar regional variations 10 . Very few studies have discussed interorbital distance at all. The current study has the largest number of participants (n = 6524) where IOD was documented in detail. Overall mean IOD for the entire population was 105.3 (range = 80–123) while for male it was 105.2 and for females it was 105.5. There was no notable gender difference in IOD. Age-based trends showed that IOD was widest among teenagers and adults but decreased in older individuals. Regionally, Khyber Pakhtunkhwa (KpK province) recorded the widest IOD (114.3 mm). Study from North India 10 has also shown a correlation with these parameters. The IOD in Uttar Pradesh was the highest while it was lowest in Delhi, Haryana and Bihar. They observed that IOD had a range between 84 and 120 mm with an average value of 100.78 mm. The value was higher in males as compared to females. Highest value was noted in adults, followed by the elderly and teenage group. Lowest values were seen in children. The relationship between EV and IOD has also been studied by us. Our analysis shows a statistically significant positive correlation between inter-orbital distance and the exophthalmometer values of the right and left eyes. Other studies have similarly observed a significant positive correlation of exophthalmometry values with base value of Hertel’s exophthalmometer (IOD) 5 , 7 , 15 , 16 . Although a good positive correlation between EV and IOD does not prove that one causes the other, it suggests that an increase in one is associated with a concurrent increase in the other 15 . Conclusion This is the largest study published so far that looks into exophthalmometry values (EV) and inter-orbital distance values (IOD). The mean EV for Pakistan has been determined to be 16.52 which is relatively higher than most of the regional studies. The mean IOD for Pakistan is calculated as 105. With 7002 participants from all over Pakistan across five different regions, this study provides baseline data for future research on the subject as well for measurement of abnormal protrusions due to different diseases like thyroid eye disease, orbital tumors, congenital anomalies etc. Similarly, normal IOD of Pakistani population determined in this study will provide a baseline for various maxillofacial and oculoplastic surgical procedures. Limitations The data has been collected through hospital based studies. Although these hospitals were tertiary care centers receiving patients from all over the region/province, yet these may not be true representative of the population. Although all the participating examiners were qualified ophthalmologists, yet the inter-observer differences cannot be ruled out. Abbreviations EV Exophthalmometry value EVOD Exophthalmometry value right eye EVOS Exophthalmometry value left eye IOD Inter-Orbital distance KpK Khyber Pakhtunkhwa province AJK Azad Jammu and Kashmir region Declarations 1-Ethics approval and consent to participate The study “Normal Range of Exophthalmometry values in Pakistani Population – A multi-center cross-sectional national study” was approved by the ethical research committee of Pakistan Oculoplastic Association (POA) (Ref. No.ERC-1/POA-22). The study adhered to the tenets of Declaration of Helsinki for human participation. Informed consent to participate was obtained from all of the participants in the study. For individuals younger than the age of 16, consent to participate was obtained from their parents or legal guardians. 2-Consent for Publication. Not Applicable. No identifying images or other personal or clinical details of participants that could compromise anonymity were obtained or used. 3-Availability of data and material The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. 4-Competing Interests No competing interests from any author 5-Funding Declaration It was a multi-center study in different institutions of the country. All the institutions supported their own part of the research by providing logistics and THERE WAS NO EXTERNAL FUNDING SOURCE FOR THIS MULTICENTER STUDY. 6-Authors’ contribution TA was a major contributor in writing the manuscript and data collection MM conceived the idea, coordinated the data collection and also provided data from his institution IH designed the study and provided data from his institution SF was a major contributor in conducting study at her institution and data provision IJ was a major contributor in conducting study at his institution and data provision FT was a major contributor in conducting study at her institution and data provision AN supervised data collection at his institution and was part of the proof reading team MIS was a major contributor in conducting study at his institution and data provision QAW conducted statistical analysis and contributed in writing the manuscript KKS was a major contributor in conducting study at his institution and data provision AY supervised data collection, analysis and validation and also contributed in manuscript writing SH was a major contributor in conducting study at his institution and data provision MA was a major contributor in conducting study at his institution and data provision AR was a major contributor in conducting study at her institution and data provision All authors read and approved the final manuscript 7-Acknowledgements Nothing to declare Email of the corresponding author, Tayyab Afghani [email protected] References Migliori ME, Gladstone GJ. 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Karti O, Selver OB, Karahan E, Zengin MO, Uyar M. The effect of age, gender, refractive status and axial length on the measurements of Hertel exophthalmometry. Open Ophthalmol 2015;9:113-5. Tsiogka A, Petrou P, Droutsas K, et al. (February 15, 2023) Hertel Exophthalmometry Values in a Greek Adult Outpatient Clinic-Based Population: Association With Demographic Factors and Systemic Disease. Cureus 15(2): e35027. DOI 10.7759/cureus.35027 Lohakitsatian P, Tunlayadechanont P, Tantitham T. Decoding Periorbital Aging: A Multilayered Analysis of Anatomical Changes. Aesth Plast Surg (2025) 49:664–671 Fledelius HC, Stubgaard M. Changes in eye position during growth and adult life as based on exophthalmometry, interpupillary distance, and orbital distance measurements. Acta Ophthalmol (Copenh) 1986;64:481–6. Majekodunmi S, Oluwole M. Normal exophthalmometry value for Nigerian. West Afr J Med 1989;8:35-7 Frueh WT, Frueh BR. Errors of single-mirror or prism Hertel exophthalmometers and recommendations for minimizing the errors. Ophthal Plast Reconstr Surg 2007;23:197-201 Nucci P, Brancato R, Bandello F, Alfarano R, Bianchi S. Normal exophthalmometric values in children. Am J Ophthalmol 1989;108:582–4. Osuobeni EP, al-Harbi AA. Normal values of ocular protrusion in Saudi Arabian male children. Optom Vis Sci 1995;72:557–64. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7333702","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":524552979,"identity":"3eb50a62-0584-4e60-b18a-b3a53f0f8e9e","order_by":0,"name":"Tayyab 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1","display":"","copyAsset":false,"role":"figure","size":68760,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea, b, c: Histogram Depicting Normative Data, EV OD and EV OS, and for Inter-Orbital Distances (IOD)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7333702/v1/e4b991fbdd71a14546530e6c.png"},{"id":92843896,"identity":"94af02a3-f206-489f-bd95-5575b3e45207","added_by":"auto","created_at":"2025-10-06 09:21:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":56891,"visible":true,"origin":"","legend":"\u003cp\u003eIndependent Samples T-Test for Normative Data Comparison of EV OD, EV OS, and IOD between genders\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7333702/v1/78a51fb825659c8929008a69.png"},{"id":92843900,"identity":"2cb03841-8300-4199-a53d-4f167b4c3d2a","added_by":"auto","created_at":"2025-10-06 09:21:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":88654,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePearson’s Correlation between age and ocular measurements\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7333702/v1/0579d4a3a8fa80b0d9ca1e65.png"},{"id":92843897,"identity":"6cf429e5-ce1c-4367-8392-74cbc88cb1d1","added_by":"auto","created_at":"2025-10-06 09:21:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":35987,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePearson’s Correlation between EV and IOD\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7333702/v1/9b252c32b1cfc24239065512.png"},{"id":96347895,"identity":"793ff174-9c1a-4734-8e6c-4d8b0709f0b2","added_by":"auto","created_at":"2025-11-20 06:38:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1493891,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7333702/v1/8659b982-f104-40ec-a061-b21c6fc982b0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Normal Range of Exophthalmometry values in Pakistani Population – A multi-center cross-sectional national study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe bony skeleton that hosts the eyeball in human being is known as orbit. Orbit is roughly a V-shaped cavity with medial walls on both sides being parallel to each other while the lateral walls are almost at right angle to each other. The eyeballs are not totally immersed in the bony orbit and part of these lie outside which actually defines the extent of our visual field. The normal amount of this ocular protrusion as measured from the lateral orbital rim to the corneal apex is called as exophthalmometry value (EV). This measurement can be made by a pair of simple millimeter rulers or by a specially designed instrument known as exophthalmometer and the process is called as exophthalmometry. Exophthalmometer simultaneously measures distance between both the outer orbital rims, called as inter-orbital distance (IOD).\u003c/p\u003e\u003cp\u003eBoth EV and IOD varies with age, gender, race and geography. Various studies have been conducted in different countries to determine these values\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, but such a study at national level has never been carried out in Pakistan before. The current study conducted all over Pakistan, comprising 7002 participants is the largest in the world so far. The objective was to determine the normal exophthalmometry value (EV) and to calculate mean inter-orbital distance (IOD) for Pakistani population.\u003c/p\u003e\u003cp\u003eThis study will serve as reference point for future research on the subject as well for measurement of abnormal protrusions (exophthalmos, proptosis) due to different diseases like thyroid eye disease, orbital tumors, congenital anomalies etc. Similarly, normal IOD of Pakistani population determined in this study will provide a baseline for various maxillofacial and oculoplastic surgical procedures.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign, Settings and Participants\u003c/h2\u003e\u003cp\u003eIt was a cross-sectional study conducted throughout Pakistan from July 2022 to June 2023. A total of 12 centers from seven cities across Pakistan conducted this survey in which a total of 7,002 participants volunteered to take part. These included Bahawalpur (one center), Lahore (three centers) and Rawalpindi (two centers) from Punjab province, Karachi (one center) from Sindh province, Mirpur (one center) from the region of Kashmir (AJK), Peshawar (two centers) from Khyber Pakhtunkhwa (KpK) province and Quetta (two centers) from Baluchistan province.\u003c/p\u003e\u003cp\u003e The study conforms to the ethical principles outlined in the Declaration of Helsinki for medical research involving human subjects.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSampling technique\u003c/h3\u003e\n\u003cp\u003eThe participants were the patients attending the outpatient department of the hospitals who were properly informed about the study and its protocol and who consented to take part in the study. A single examiner in each center recorded the EV and IOD reading using Hertel\u0026rsquo;s Exophthalmometer. (It may be noted that all qualified ophthalmologists are trained in performing Hertel Exophthalmometry).\u003c/p\u003e\u003cp\u003eInclusion criteria included all healthy individuals 9 years and above, while exclusion criteria were \u003cb\u003ec\u003c/b\u003eonditions causing proptosis like thyroid eye disease, orbital, paraorbital masses and inflammations, obvious squint, abnormal orbit development like Crouzen Syndrome, unilateral or bilateral phthisis bulbi or microophthalmia, unilateral or bilateral buphthalmos or keratoconus, sunken eyes due to dehydration, malnutrition, etc., and myopia or hypermetropia of more than 6 diopters.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThe designated ophthalmologist in each study center performed Hertel exophthalmometry on all outpatients meeting laid down criteria. The basic demographic profile for each participant was documented. It included age, gender and district of domicile. The basic clinical examination was conducted for all the participants of the study including visual acuity, intra-ocular pressure, anterior segment examination with slit-lamp and posterior segment examination. The Hertel reading was entered into the proforma that included EV reading for each eye along with inter-orbital distance.\u003c/p\u003e\n\u003ch3\u003eStatistics\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics were calculated for continuous variables such as Age, EVOD, EVOS, and IOD, including measures like mean, standard deviation, and standard error. For categorical variables such as gender, frequency distributions were computed. For inferential statistics, a paired t-test was applied to assess the difference between EVOD and EVOS. An independent t-test was used to examine gender-based differences. Additionally, Pearson correlation analysis was conducted to evaluate the relationships between IOD and EVOS, as well as between EVOD and EVOS. A significance level of 5% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was maintained throughout all statistical tests.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study analyzed data from 7002 participants across all provinces of Pakistan, with a mean age of 38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;17.5 years, revealing significant variations by region, gender, and age. The average exophthalmometry measurements for the right eye (EV OD) and left eye (EV OS) were 16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71 mm and 16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77 mm, respectively, while the mean inter-orbital distance (IOD) was 105.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20 mm. The EV asymmetry of 2 mm or more between the two eyes was found in 8.51% of the participants. Females had significantly higher EV OD and EV OS values compared to males (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with no notable gender difference in IOD (p\u0026thinsp;=\u0026thinsp;0.080). Age-based trends showed that adults had the highest EV OD and EV OS values, while children had the lowest, and IOD was widest among teenagers and adults but decreased in older individuals. Regionally, Khyber Pakhtunkhwa recorded the widest IOD (114.3 mm), while Azad Jammu \u0026amp; Kashmir had the highest EV OD and EV OS values (20 mm). Pearson\u0026rsquo;s correlation analysis showed weak positive relationships between age and EV OD (r\u0026thinsp;=\u0026thinsp;0.048, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and EV OS (r\u0026thinsp;=\u0026thinsp;0.056, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a weak negative relationship between age and IOD (r = -0.123, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings provide comprehensive normative data on exophthalmometry measurements and inter-orbital distance for the Pakistani population, emphasizing demographic variations.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the age-related demographic characteristics of 7,002 participants from a multi-center study across Pakistan, including Punjab, Sindh, Khyber Pakhtunkhwa (KPK), Baluchistan, and Azad Jammu \u0026amp; Kashmir (AJK). The data, stratified by gender, includes the total number of participants (N), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median\u0026thinsp;\u0026plusmn;\u0026thinsp;interquartile range, and age range. Punjab contributed the highest participants (4,364). AJK participants had the oldest average age (43.9 years). Males generally had a slightly younger average age compared to females across most regions, with Baluchistan showing an exception where females were older on average.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics (age) across different regions of Pakistan\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" 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colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.6(30.0\u0026thinsp;\u0026plusmn;\u0026thinsp;27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBaluchistan\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e27.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7(25.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e26.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.83(25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e31.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.94(26.5\u0026thinsp;\u0026plusmn;\u0026thinsp;28.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u0026ndash;67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAJK\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e506\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.9\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7(43.0\u0026thinsp;\u0026plusmn;\u0026thinsp;23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u0026ndash;75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4(43.0\u0026thinsp;\u0026plusmn;\u0026thinsp;21.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u0026ndash;75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e308\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9(43.0\u0026thinsp;\u0026plusmn;\u0026thinsp;23.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u0026ndash;75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents normative data for exophthalmometry values of the right eye (EV OD), left eye (EV OS), and inter-orbital distance (IOD) across Pakistan and its regions, including Punjab, Sindh, Khyber Pakhtunkhwa (KPK), Baluchistan, and Azad Jammu \u0026amp; Kashmir (AJK). The data includes the number of participants (N), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), median\u0026thinsp;\u0026plusmn;\u0026thinsp;interquartile range (IQR), standard error (SE), range, statistical values, 95% confidence intervals (lower and upper bounds), and p-values. Nationally, the mean EV OD and EV OS are 16.5 mm and 16.6 mm, respectively, with a mean IOD of 105.3 mm. Regional differences are evident, with KPK showing the highest mean IOD (114.3 mm), and AJK demonstrating the highest mean EV OD and EV OS values (20 mm for both eyes). Baluchistan has the lowest mean values for EV OD (15 mm) and EV OS (14.9 mm). All measurements across regions show statistically significant variations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).This table highlights the regional variability and provides a comprehensive reference for exophthalmometry and inter-orbital distance norms in Pakistan.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNormative Data for Exophthalmometry value (EV) \u0026amp; Inter-Orbital Distance (IOD)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD(Median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUpper\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePakistan\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71(17\u0026thinsp;\u0026plusmn;\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e508\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e16.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77(17\u0026thinsp;\u0026plusmn;\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e16.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6524\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e105.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20(107.0\u0026thinsp;\u0026plusmn;\u0026thinsp;18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80\u0026ndash;123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e105.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e`105.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePunjab\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4364\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.62(16\u0026thinsp;+\u0026thinsp;4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0396\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u0026ndash;26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e16.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4364\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67(16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0405\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u0026ndash;26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e700\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e105.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e106.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3984\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e106.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.58(110\u0026thinsp;\u0026plusmn;\u0026thinsp;17.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80\u0026ndash;123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e405\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e16.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSindh\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21(95\u0026thinsp;\u0026plusmn;\u0026thinsp;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u0026ndash;22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20(17\u0026thinsp;\u0026plusmn;\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0661\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u0026ndash;22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e16.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e97.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.49(17\u0026thinsp;\u0026plusmn;\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.2847\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80\u0026ndash;120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e96.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e97.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKPK\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e863\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67 (16\u0026thinsp;\u0026plusmn;\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0910\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e16.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e863\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e17.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91 (17\u0026thinsp;\u0026plusmn;\u0026thinsp;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0990\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e17.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e863\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e114.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.40 (115\u0026thinsp;\u0026plusmn;\u0026thinsp;10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.2178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85\u0026ndash;123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e525\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e113.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e114.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBaluchistan\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85 (15\u0026thinsp;\u0026plusmn;\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u0026ndash;23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e157.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e15.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86 (15\u0026thinsp;\u0026plusmn;\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9-23.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e157.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e15.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e113.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07 (115\u0026thinsp;\u0026plusmn;\u0026thinsp;10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.784\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u0026ndash;120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e59.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e111.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e115.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAJK\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e506\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99 (20\u0026thinsp;\u0026plusmn;\u0026thinsp;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0886\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17\u0026ndash;23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e19.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e20.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEV OS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e506\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85 (20\u0026thinsp;\u0026plusmn;\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0820\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e19.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e20.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e506\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e99.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79 (99\u0026thinsp;\u0026plusmn;\u0026thinsp;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1687\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e94\u0026ndash;106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e592\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e99.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e100.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides normative data for exophthalmometry measurements (EV OD and EV OS) and inter-orbital distance (IOD) categorized by age groups: children, teenagers, adults, and elders. The table includes the number of participants (N), percentage (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), median\u0026thinsp;\u0026plusmn;\u0026thinsp;interquartile range (IQR), standard error (SE), range, and 95% confidence intervals (lower and upper bounds). Children exhibit the lowest mean EV OD (14.4 mm) and EV OS (14.7 mm), while adults have the highest mean values (16.7 mm and 16.8 mm, respectively). IOD is widest among teenagers (mean 105.8 mm) and adults (mean 105.6 mm), while elders show a significant reduction (mean 101.2 mm).The interquartile range and standard deviation indicate greater variability in children compared to other age groups. This table provides valuable insights into age-related changes in ocular measurements, serving as a reference for clinical and research applications.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAge-Based Normative Data for Exophthalmometry Values and Inter-Orbital Distance\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e95% Confidence Interval\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEVOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD(Median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUpper\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChildren (9-15years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15(14.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.3003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.00\u0026ndash;29.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeenagers (16-19years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e865\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51(15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0853\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.00\u0026ndash;25.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdults (20\u0026ndash;69 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5632\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67(17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.00\u0026ndash;21.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElders (70-100years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98(16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.1498\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.00\u0026ndash;23.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEVOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChildren (9-15years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29(14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.3136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.00\u0026ndash;21.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeenagers (16-19years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e865\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53(15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0860\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.00\u0026ndash;25.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdults (20\u0026ndash;69 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5632\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73(17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.00\u0026ndash;29.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElders (70-100years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01(17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.1515\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.00\u0026ndash;23.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChildren(9-15years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.55(107.5\u0026thinsp;\u0026plusmn;\u0026thinsp;23.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.2188\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80\u0026ndash;123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e100.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e105.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeenagers(16-19years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e748\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e105.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.24(110.0\u0026thinsp;\u0026plusmn;\u0026thinsp;19.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80\u0026ndash;123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e105.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e106.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdults (20\u0026ndash;69 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5280\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e105.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.92(107.0\u0026thinsp;\u0026plusmn;\u0026thinsp;18.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.1365\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80\u0026ndash;123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e105.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e105.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElders(70-100years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e390\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e101.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.25(99.0\u0026thinsp;\u0026plusmn;\u0026thinsp;16.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80\u0026ndash;123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e100.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e102.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGender Differences in Exophthalmometry Measurements and Inter-Orbital Distance\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEV OD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4424\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0407\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e-8.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2578\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e16.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0528\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEV OS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4424\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e-9.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2578\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0532\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e105.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.1571\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e-1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.080\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e105.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.2123\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEVOD vs EVOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEVOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e-8.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEVOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0331\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e compares exophthalmometry measurements (EV OD and EV OS) and inter-orbital distance (IOD) between males and females, as well as a paired comparison between EV OD and EV OS across the total population. The analysis includes the number of participants (N), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), standard error (SE), t-statistic, and p-value. Females have significantly higher mean values for EV OD (16.8 mm vs. 16.3 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and EV OS (17.0 mm vs. 16.3 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to males. IOD is similar between males (105.2 mm) and females (105.5 mm), with no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.080). Paired comparison of EV OD and EV OS across the entire cohort shows a statistically significant difference, with EV OS being slightly higher on average (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings highlight gender-based differences in ocular measurements, with females generally exhibiting larger exophthalmometry values.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePearson\u0026rsquo;s Correlation between age and ocular measurements\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePearson's r\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEV OD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026nbsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEV OS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026nbsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026nbsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis table presents Pearson\u0026rsquo;s correlation coefficients (r) and p-values for the relationships between age and ocular measurements, including exophthalmometry values of the right eye (EV OD), left eye (EV OS), and inter-orbital distance (IOD). A weak positive correlation exists between age and EV OD (r\u0026thinsp;=\u0026thinsp;0.048, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and EV OS (r\u0026thinsp;=\u0026thinsp;0.056, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating slight increases in these values with age. Conversely, age is weakly negatively correlated with IOD (r = -0.123, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting a gradual decrease in inter-orbital distance as age increases. While statistically significant, these correlations indicate a minimal effect of age on ocular measurements.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation between Inter-Orbital Distance and Exophthalmometer Values\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePearson\u0026rsquo;s \u003cem\u003er\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI Lower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI Upper\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOD \u0026ndash; EV OD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.326\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.308\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOD \u0026ndash; EV OS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.322\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe analysis shows a statistically significant positive correlation between inter-orbital distance and the exophthalmometer value of the right and left eyes. This suggests that greater inter-orbital distance is associated with greater forward positioning of the left eye, as measured by exophthalmometry. The 95% confidence interval for the correlation coefficient (0.308 to 1.000) indicates a moderate-to-strong relationship and confirms the consistency of this positive association. Given the one-tailed test used, these findings support the directional hypothesis that IOD is positively associated with eye protrusion.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e compares exophthalmometry measurements (EV OD and EV OS) and inter-orbital distance (IOD) between genders and includes a paired analysis of EV OD and EV OS for the total population. Females have significantly higher mean values for EV OD (16.8 mm vs. 16.3 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and EV OS (17.0 mm vs. 16.3 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than males. No significant difference was observed in IOD between males (105.2 mm) and females (105.5 mm, p\u0026thinsp;=\u0026thinsp;0.080). A paired analysis revealed a significant difference between EV OD and EV OS, with EV OS being slightly higher (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results underscore gender-based differences in exophthalmometry values, with females exhibiting larger measurements.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the Pearson's correlation coefficients (r) and their corresponding p-values, indicating the relationships between age and ocular measurements. A weak positive correlation was observed between age and Exophthalmometer Ocular Dexter (EV OD, r\u0026thinsp;=\u0026thinsp;0.048, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and between age and Exophthalmometer Ocular Sinister (EV OS, r\u0026thinsp;=\u0026thinsp;0.056, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). In contrast, a weak negative correlation was found between age and Inter-Orbital Distances (IOD, r = -0.123, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), all of which are statistically significant.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith 7002 participants, this is the largest study on exophthalmometry values (EV) and interorbital distance measurements published in English literature so far. The study provides detailed data on exophthalmometry values and inter-orbital distance in Pakistani population for the first time. With overall mean for EV 16.52, EV range was 8\u0026ndash;29. The mean EV were 16.5mm and 16.6mm in right and left eye respectively. The mean EV for males and females were 16.29 mm and 16.90 mm respectively. The mean inter-orbital distance (IOD) was found to be 105.3 mm with a range of 80\u0026ndash;123. The mean IOD for male and female were 105.2 and 105.5 respectively\u003c/p\u003e\n\u003cp\u003eWe used Hertel\u0026rsquo;s Exophthalmometer for measuring EVs and IOD. While various other techniques ranging from instrumental to radiological had been used to measure this value in different studies, the use of Hertel\u0026rsquo;s exophthalmometer remains the most favored\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Incorrect measurements might occur if Hertel footplates are not correctly positioned on the lateral orbital rim or the device is not aligned horizontally. This base measurement has great impact on final measurement obtained\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. It has been reported that every 2 mm medial displacement of footplate results in 3.8 mm under-reading of proptosis\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. All the observers who conducted exophthalmometry in this study were fully trained and qualified ophthalmologists.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003cbr\u003e\n \u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eA comparison of EVs \u0026amp; IOD from different studies conducted across the globe\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePlace of Study\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSample size\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMean Exophthalmometry values (EV)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eInterorbital distance (IOD)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTurkey\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026ndash;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSri Lanka\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026ndash;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNigeria\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026ndash;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChinese-Han\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026ndash;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e108\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u0026ndash;122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChinese-HK\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u0026ndash;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIran (Meta-analysis of four studies)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u0026ndash;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndian (North)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026ndash;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84\u0026ndash;120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurrent Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026ndash;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e105.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80\u0026ndash;123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab8\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCurrent study-Summary of Results\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eExophthalmometry values - EV (N\u0026thinsp;=\u0026thinsp;7004)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eInter Orbital Distance-IOD (N\u0026thinsp;=\u0026thinsp;6524)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean for males\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean for females\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean for Right eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean for left eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEV Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean for male\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean for female\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIOD Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026ndash;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80\u0026ndash;123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere are well established data in the literature in terms of upper and lower limits of normal eye protrusions for various populations\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. In most of these studies, upper limit of ocular protrusion is accepted to be 21 mm, however, this cannot be considered as universal because of race and geography, and upper limit for one race may not be the same for the others. The EVs in Pakistani population was found to be in the range of 8\u0026ndash;29. The upper limit of 29 is higher than most of the large studies published\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. (Only studies over 1000 participants were included for comparison (Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e). The mean EV ranged from minimum of 13 in a Turkish study\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e to maximum of 16.52 in our study.\u003c/p\u003e\n\u003cp\u003eThe effect of age was also studied in detail. Children showed the lowest mean EV OD (14.4 mm) and EV OS (14.7 mm), while adults had the highest mean values (16.7 mm and 16.8 mm, respectively). The elderly group (\u0026gt;\u0026thinsp;70 years) displayed a reduction in these values. Pearson\u0026rsquo;s correlation showed a weak positive relation between age and EVs. While statistically significant, these correlations indicate a minimal effect of age on ocular measurements in our study. This is consistent with observation of Mourits et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e who reported that age has no effect on proptosis and proposed that a larger sample size might reveal a small age effect. However there are other conflicting reports regarding the effect of age on the exophthalmometry values. Beden et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e concluded that the EV decreases significantly after third decade. Kashkouli et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e showed that age had a positive correlation in children and teenagers whereas a negative correlation was observed in adults. Wu et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e in his study found that the EV was lowest in children and highest in adults. Similarly, Jarusaitiene et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e revealed the EV increases with the growing age. However, studies by Chan, Cheung, Karti and Tsiogka et al suggested that age had a negative correlation\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. We observed that the highest values were recorded in adults followed by teenagers and the lower values were observed in children and the elderly group. The ocular protrusion increases from childhood to adulthood because of facial modeling and/or increase in orbital soft tissue volume\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. However a recent study has for the first time looked into comprehensive understanding of all periorbital components, including upper and lower orbital fat, orbital cavity volume, globe volume, and globe position, in the context of aging. This study from Thailand\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e has shown that there was no statistically significant correlation between age and the volume of anterior, posterior, or total upper orbital fat. Total orbital fat volume was found to increase in relation to aging with statistical significance. On the other hand orbital cavity volume was observed to increase in relation to aging with statistical significance. Interestingly globe volume exhibited a significant decrease with age. There was a decrease in the anteroposterior dimension of globe position with age, indicating an enophthalmic tendency. However, there was no change in globe position in the vertical plane.\u003c/p\u003e\n\u003cp\u003eThe association between gender and EV shows wide variation across different studies. Number of studies\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e reported significantly higher values in males than in females. Kashkouli et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e and Wu et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e did not find a statistically significant correlation between gender and EV in their study. A recent Greek study\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e showing a statistically significant negative correlation between EV and female gender\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e attributed the higher male EV to the larger body structure. Males in general are taller, heavier with larger hip and waist circumference, and are likely to have higher EV\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Similarly a recent study based on MRI measurements showed that males exhibited larger volumes of total orbital fat than females\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. However in total contrast, our study which is the largest so far with 2578 female participants, has shown statistically significant gender-based differences in ocular measurements, with females exhibiting larger exophthalmometry values.\u003c/p\u003e\n\u003cp\u003eThe effect of laterality on EV has been shown to be variable. Some studies\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e have reported a higher value in the left eye. Results of meta-analysis on 3,696 normal Iranians\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e showed that the mean eye protrusion was not different between the right and left eyes. Some earlier studies\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e also reported no significant difference. Higher ocular protrusion on the right side has also been reported\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Paired comparison of EV OD and EV OS in our study across the entire cohort shows a statistically significant difference, with EV OS being slightly higher on average (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Apparently there is no reason accounting for this difference. A parallax error due to an apparent change in the position of the eye when the examiner changes position might account for the difference.\u003c/p\u003e\n\u003cp\u003eRegional differences in the EV have also been reported. In the current study, regional differences are evident with AJK (Northern region) demonstrating the highest mean EV OD and EV OS values (20 mm for both eyes) and Baluchistan (southwestern region) has the lowest mean values for EV OD (15 mm) and EV OS (14.9 mm). All measurements across regions show statistically significant variations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A recent north Indian study has also shown similar regional variations\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eVery few studies have discussed interorbital distance at all. The current study has the largest number of participants (n\u0026thinsp;=\u0026thinsp;6524) where IOD was documented in detail. Overall mean IOD for the entire population was 105.3 (range\u0026thinsp;=\u0026thinsp;80\u0026ndash;123) while for male it was 105.2 and for females it was 105.5. There was no notable gender difference in IOD. Age-based trends showed that IOD was widest among teenagers and adults but decreased in older individuals. Regionally, Khyber Pakhtunkhwa (KpK province) recorded the widest IOD (114.3 mm). Study from North India\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e has also shown a correlation with these parameters. The IOD in Uttar Pradesh was the highest while it was lowest in Delhi, Haryana and Bihar. They observed that IOD had a range between 84 and 120 mm with an average value of 100.78 mm. The value was higher in males as compared to females. Highest value was noted in adults, followed by the elderly and teenage group. Lowest values were seen in children.\u003c/p\u003e\n\u003cp\u003eThe relationship between EV and IOD has also been studied by us. Our analysis shows a statistically significant positive correlation between inter-orbital distance and the exophthalmometer values of the right and left eyes. Other studies have similarly observed a significant positive correlation of exophthalmometry values with base value of Hertel\u0026rsquo;s exophthalmometer (IOD)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Although a good positive correlation between EV and IOD does not prove that one causes the other, it suggests that an increase in one is associated with a concurrent increase in the other\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis is the largest study published so far that looks into exophthalmometry values (EV) and inter-orbital distance values (IOD). The mean EV for Pakistan has been determined to be 16.52 which is relatively higher than most of the regional studies. The mean IOD for Pakistan is calculated as 105. With 7002 participants from all over Pakistan across five different regions, this study provides baseline data for future research on the subject as well for measurement of abnormal protrusions due to different diseases like thyroid eye disease, orbital tumors, congenital anomalies etc. Similarly, normal IOD of Pakistani population determined in this study will provide a baseline for various maxillofacial and oculoplastic surgical procedures.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThe data has been collected through hospital based studies. Although these hospitals were tertiary care centers receiving patients from all over the region/province, yet these may not be true representative of the population. Although all the participating examiners were qualified ophthalmologists, yet the inter-observer differences cannot be ruled out.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eEV\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Exophthalmometry value\u003c/p\u003e\n\u003cp\u003eEVOD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Exophthalmometry value right eye\u003c/p\u003e\n\u003cp\u003eEVOS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Exophthalmometry value left eye\u003c/p\u003e\n\u003cp\u003eIOD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Inter-Orbital distance\u003c/p\u003e\n\u003cp\u003eKpK\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Khyber Pakhtunkhwa province\u003c/p\u003e\n\u003cp\u003eAJK \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Azad Jammu and Kashmir region\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e1-Ethics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study \u0026ldquo;Normal Range of Exophthalmometry values in Pakistani Population \u0026ndash; A multi-center cross-sectional national study\u0026rdquo; was approved by the ethical research committee of Pakistan Oculoplastic Association (POA) (Ref. No.ERC-1/POA-22). The study adhered to the tenets of Declaration of Helsinki for human participation.\u003c/p\u003e\n\u003cp\u003eInformed consent to participate was obtained from all of the participants in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor individuals younger than the age of 16, consent to participate was obtained from their parents or legal guardians.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2-Consent for Publication.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot Applicable. No identifying images or other personal or clinical details of participants that could compromise anonymity were obtained or used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-Availability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4-Competing Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo competing interests from any author\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5-Funding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was a multi-center study in different institutions of the country. All the institutions supported their own part of the research by providing logistics and THERE WAS NO EXTERNAL FUNDING SOURCE FOR THIS MULTICENTER STUDY.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6-Authors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTA was a major contributor in writing the manuscript and data collection\u003c/p\u003e\n\u003cp\u003eMM conceived the idea, coordinated the data collection and also provided data from his institution\u003c/p\u003e\n\u003cp\u003eIH designed the study and provided data from his institution\u003c/p\u003e\n\u003cp\u003eSF was a major contributor in conducting study at her institution and data provision\u003c/p\u003e\n\u003cp\u003eIJ was a major contributor in conducting study at his institution and data provision\u003c/p\u003e\n\u003cp\u003eFT was a major contributor in conducting study at her institution and data provision\u003c/p\u003e\n\u003cp\u003eAN supervised data collection at his institution and was part of the proof reading team\u003c/p\u003e\n\u003cp\u003eMIS was a major contributor in conducting study at his institution and data provision\u003c/p\u003e\n\u003cp\u003eQAW conducted statistical analysis and contributed in writing the manuscript\u003c/p\u003e\n\u003cp\u003eKKS was a major contributor in conducting study at his institution and data provision\u003c/p\u003e\n\u003cp\u003eAY supervised data collection, analysis and validation and also contributed in manuscript writing\u003c/p\u003e\n\u003cp\u003eSH was a major contributor in conducting study at his institution and data provision\u003c/p\u003e\n\u003cp\u003eMA was a major contributor in conducting study at his institution and data provision\u003c/p\u003e\n\u003cp\u003eAR was a major contributor in conducting study at her institution and data provision\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7-Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNothing to declare\u003c/p\u003e\n\u003cp\u003eEmail of the corresponding author, Tayyab Afghani\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMigliori ME, Gladstone GJ. Determination of the normal range of exophthalmometric values for black and white adults. Am J Ophthalmol 1984;98:438-42.\u003c/li\u003e\n \u003cli\u003eTerwee CB, Prummel MF, Gerding MN, Kahaly GJ, Dekker FW, Wiersinga WM. Measuring disease activity to predict therapeutic outcome in Graves\u0026rsquo; ophthalmopathy. Clin Endocrinol 2005;62:145-55.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAmeri H, Fenton S. Comparison of unilateral and simultaneous bilateral measurement of the globe position, using the Hertel exophthalmometer. Ophthal Plast Reconstr Surg 2004; 20: 448-51.\u003c/li\u003e\n \u003cli\u003eLam AK, Lam CF, Leung WK, Hung PK. Intra-observer and inter-observer variation of Hertel exophthalmometry. Ophthalmic Physiol Opt 2009;29:472-6\u003c/li\u003e\n \u003cli\u003eChan WO, Madge SN, Senaratne \u0026nbsp;T, Senanayake S, Selva D, Casson RJ. Exophthalmometric values and their biometric correlates: The Kandy Eye Study\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eClinical and Experimental Ophthalmology 2009; 37: 496\u0026ndash;502 doi: 10.1111/j.1442-9071.2009.02087.x)\u003c/li\u003e\n \u003cli\u003eIbraheem WA, Ibraheem AB, Bekibele CO. Exophthalmometric value and palpebral fissure dimension in an African population. Afr J Med Health Sci 2014;13:90-4\u003c/li\u003e\n \u003cli\u003eWu, D., Liu, X., Wu, D. Di X , Guan H, Shan Z \u0026amp; Teng W\u003cem\u003e.\u003c/em\u003e Normal Values of Hertel Exophthalmometry in a Chinese Han Population from Shenyang, Northeast China. \u003cem\u003eSci Rep\u003c/em\u003e 5, 8526 (2015). https://doi.org/10.1038/srep08526\u003c/li\u003e\n \u003cli\u003eCheung JJC, Chang DL, Chan JC, Choy BNK, Shih KC, Wong JKW, Ng ALK, Shum JWH, Ni MY, Lai JSM, Leung GM, Wong IYH. Exophthalmometry values in the Hong Kong Chinese adult population from a population-based study. Medicine 2019;98:47(e17993).\u003c/li\u003e\n \u003cli\u003eBagheri A, Shahraki K, Arabi A, Kashkouli MB. Normal Exophthalmometry Values in Iranian Population: A Meta-analysis: A complete translation from Farsi. J Ophthalmic Vis Res 2021;16:470\u0026ndash;478\u003c/li\u003e\n \u003cli\u003eRevankar S, Mehta A. Determination of exophthalmometry values in the North Indian population. Indian J Ophthalmol 2022;70:3083-7\u003c/li\u003e\n \u003cli\u003eKim IT, Choi JB. Normal range of exophthalmos values on orbit computerized tomography in Koreans. Ophthalmologica 2001;215: 156-62\u003c/li\u003e\n \u003cli\u003eSodhi KP, Gupta VP, Pandey RM. Exophthalmometric values in a normal Indian population. Orbit 2001; 20: 1-9\u003c/li\u003e\n \u003cli\u003eMourits MP, Lombardo SH, van der Sluijs FA, Fenton S. Reliability of exophthalmos measurement and the exophthalmometry value distribution in a healthy Dutch population and in Graves\u0026rsquo; patients. An exploratory study. Orbit 2004; 23: 161-8.\u003c/li\u003e\n \u003cli\u003eBeden U, Ozarslan Y, Ozt\u0026uuml;rk HE, S\u0026ouml;nmez B, Erkan D, Oge I. Exophthalmometry values of Turkish adult population and the effect of age, sex, refractive status, and Hertel base values on Hertel readings. Eur J Ophthalmol 2008;18:165\u0026ndash;71.\u003c/li\u003e\n \u003cli\u003eKashkouli MB, Nojomi M, Parvaresh MM, Sanjari MS, Modarres M, Noorani MM. Normal values of Hertel exophthalmometry in children, teenagers, and adults from Tehran, Iran. Optom Vis Sci 2008;85:1012\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eJarusaitiene D, Lisicova J, Krucaite A, Jankauskiene J. Exophthalmometry value distribution in healthy Lithuanian children and adolescents. Saudi J Ophthalmol 2016;30:92\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eKarti O, Selver OB, Karahan E, Zengin MO, Uyar M. The effect of age, gender, refractive status and axial length on the measurements of Hertel exophthalmometry. Open Ophthalmol 2015;9:113-5.\u003c/li\u003e\n \u003cli\u003eTsiogka A, Petrou P, Droutsas K, et al. (February 15, 2023) Hertel Exophthalmometry Values in a Greek Adult Outpatient Clinic-Based Population: Association With Demographic Factors and Systemic Disease. Cureus 15(2): e35027. DOI 10.7759/cureus.35027\u003c/li\u003e\n \u003cli\u003eLohakitsatian P, Tunlayadechanont P, Tantitham T. \u0026nbsp;Decoding Periorbital Aging: A Multilayered Analysis of Anatomical Changes. Aesth Plast Surg (2025) 49:664\u0026ndash;671\u003c/li\u003e\n \u003cli\u003eFledelius HC, Stubgaard M. Changes in eye position during growth and adult life as based on exophthalmometry, interpupillary distance, and orbital distance measurements. Acta Ophthalmol (Copenh) 1986;64:481\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eMajekodunmi S, Oluwole M. Normal exophthalmometry value for Nigerian. West Afr J Med 1989;8:35-7\u003c/li\u003e\n \u003cli\u003eFrueh WT, Frueh BR. Errors of single-mirror or prism Hertel exophthalmometers and recommendations for minimizing the errors. Ophthal Plast Reconstr Surg 2007;23:197-201\u003c/li\u003e\n \u003cli\u003eNucci P, Brancato R, Bandello F, Alfarano R, Bianchi S. Normal exophthalmometric values in children. Am J Ophthalmol 1989;108:582\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eOsuobeni EP, al-Harbi AA. Normal values of ocular protrusion in Saudi Arabian male children. Optom Vis Sci 1995;72:557\u0026ndash;64.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Exophthalmometry value, inter-orbital distance, Proptosis, Exophthalmos","lastPublishedDoi":"10.21203/rs.3.rs-7333702/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7333702/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground. Measurements of ocular protrusion and inter-orbital distance has not been measured in Pakistan at national level before. The current study comprising 7002 participants is the largest in the world so far.The objective was to determine the normal exophthalmometry value (EV) and to calculate mean inter-orbital distance (IOD) for Pakistani population.\u003c/p\u003e\n\u003cp\u003eMethods. It was a cross-sectional study conducted from July 2022 to June 2023. A total of 12 centers from seven cities across Pakistan conducted this survey. The participants were the patients attending the outpatient department of the hospitals. A single examiner in each center recorded the EV and IOD reading using Hertel’s Exophthalmometer.\u003c/p\u003e\n\u003cp\u003eResults. The participants had a mean age of 38.2 ± 17.5 years. The average exophthalmometry measurements for the right and left eyes were 16.5 ± 2.71 mm and 16.6 ± 2.77 mm, respectively, while the mean inter-orbital distance (IOD) was 105.3 ± 10.20 mm. Females had significantly higher EV compared to males (p \u0026lt; 0.001), with no notable gender difference in IOD (p = 0.080). Adults had the highest EV values, while children had the lowest, and IOD was widest among teenagers and adults but decreased in older individuals. Regionally, Khyber Pakhtunkhwa recorded the widest IOD (114.3 mm), while Azad Jammu \u0026amp; Kashmir had the highest EV (20 mm). Descriptive statistics were calculated for continuous variables and frequency distributions were computed for categorical variables. For inferential statistics, a paired t-test was applied to assess the difference between EVOD and EVOS. An independent t-test was used to examine gender-based differences. Additionally, Pearson correlation analysis was conducted to evaluate the relationships between IOD and EVOS, as well as between EVOD and EVOS. A significance level of 5% (p \u0026lt; 0.05) was maintained throughout all statistical tests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion. The study provides detailed data on EV and IOD in Pakistani population for the first time. This study provides baseline data for future research on the subject as well for measurement of abnormal protrusions due to different diseases Similarly, normal IOD of Pakistani population determined in this study will provide a baseline for various maxillofacial and oculoplastic surgical procedures.\u003c/p\u003e","manuscriptTitle":"Normal Range of Exophthalmometry values in Pakistani Population – A multi-center cross-sectional national study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-06 09:21:07","doi":"10.21203/rs.3.rs-7333702/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d659da36-3865-448f-9f44-bb6500090fa0","owner":[],"postedDate":"October 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-20T06:38:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-06 09:21:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7333702","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7333702","identity":"rs-7333702","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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