The Effect of Age, Gender, Refractive Status and Axial Length on the Measurements of Hertel Exophthalmometry

Omer Karti 1, Ozlem B Selver 2, Eyyup Karahan*, 3, Mehmet O Zengin 4, Murat Uyar 3
1 Torbali State Hospital, Department of Ophthalmology, Izmir, Turkey
2 Ege University, Department of Ophthalmology, Izmir, Turkey
3 Sifa University, Department of Ophthalmology, İzmir, Turkey
4 Izmir University, Department of Ophthalmology, İzmir, Turkey

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© Karti et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Narlı Mah. Ecem Sok. Kayısıkent Sitesi, C Blok D:7 Narlıdere, İzmir, Turkey; Tel: 90 232 278 8111, 90 232 278 6804; E-mail:


Purpose :

To evaluate the normal distribution of exophthalmometric values in Turkish adult population and the effect of age, gender, refractive status and axial length on globe position.

Methods :

One hundred and twenty-two males and 114 healthy females with age ranging from 18 to 87 years were included in the study. The study population was recruited from patients presenting to our institution for routine refractive examination. Hertel exophthalmometer was used to measure the degree of ocular protrusion. Effect of age, refractive error, interpupillary distance, and axial length on globe position was detected with linear regression analyses.

Results :

The mean Hertel exophthalmometric size was 15.7+2.6 mm (range; 11 to 21 mm). The mean value for males was 16.1±2.6 mm (range; 11 to 21 mm), and for females 15.5±2.6 mm (range; 11 to 20 mm). The mean distance between the lateral rims of the orbit was 102 + 5.1 mm (range; 88 to 111mm). The mean exophthalmometric values were not statistically different in males and females. Age and mean spherical equivalents were negatively correlated with exophthalmometric measurements. Axial length was positively correlated with exophthalmometric measurements.

Conclusion :

The exophthalmometric measurement of the eye is affected by the age, spherical equivalent and the axial length. Standard normative values of the Hertel exophthalmometric measurements should be reevaluated with larger samples.

Keywords: Axial length, exophthalmometry, spherical equivalent, Turkish population.