What is Exophthalmos?
Exophthalmos or Bulging Eyes also known as Exophthalmia is an ophthalmologic condition in which the eyeball protrudes out of the eye socket. This can be both unilateral and bilateral. If Exophthalmos or the condition of Bulging Eyes, despite being identified, is left untreated then it may lead to the patient being unable to close the eyes completely while sleeping. The patient may also be at risk for developing superior limbic keratoconjunctivitis which is a condition in which there is inflammation of the area just above the cornea as a result of constant rubbing that takes place while blinking the eyes due to Exophthalmos or Bulging Eyes. Exophthalmos may also cause compression of the optic nerve causing poor vision or even in some cases complete blindness. Exophthalmos normally develops when there is something wrong with the thyroid gland and it is not functioning the way it should.
What are the Causes of Exophthalmos or Bulging Eyes?
When it comes to the causes of Exophthalmos or Bulging Eyes, the following are the some of the most common causes:
Graves Disease: This is the most common cause of Exophthalmos or Bulging Eyes. This is an autoimmune condition which causes increased production of thyroid hormones resulting in hyperthyroidism. Exophthalmos or Bulging Eyes may not occur at the onset of a thyroid problem but may occur long after it has started or even before it starts. It is an autoimmune condition in which the immune system of the body starts attacking the healthy tissue. When the immune system attacks the thyroid gland it starts producing excess hormone resulting in hyperthyroidism leading to Exophthalmos. Exophthalmos or Bulging Eyes can also be caused sometimes due to a trauma to the eye, development of a cyst or a tumor.
What are the Symptoms of Exophthalmos or Bulging Eye?
The classic presenting feature of Exophthalmos is a protruding or bulging eyeballs. As stated, Graves Disease is the most common cause of Exophthalmos or Bulging Eyes hence the signs and symptoms of Graves Disease are:
- Eye pain
- Dry eyes
- Irritation in the eyes
- Photophobia
- Excessive Lacrimation
- Double vision
- Progressive loss of eyesight in some cases
- Difficulty moving the eyes
- Anxiety
- Raised appetite
- Insomnia.
How is Exophthalmos or Bulging Eye is Diagnosed?
In majority of the cases the presence of a bulging eyeball is good enough for the physician to diagnose Exophthalmos but since Exophthalmos or Bulging Eyes may point to some underlying condition hence it is important to diagnose that underlying condition. To begin with the patient will be referred to an ophthalmologist. The ophthalmologist will then conduct a series of tests in order to identify a cause for Exophthalmos or Bulging Eyes. Some of the tests that may be conducted are:
Thyroid Function Tests : This will be done to see if the thyroid is functioning normally or not.
Exophthalmometer : This is an instrument that measures the degree of Exophthalmos and also whether the patient is able to move the eyes normally or not.
Imaging: The physician may also recommend imaging in the form of CT scan of the orbits to look at the internal structures to see whether the optic nerves are compressed or not.
How is Exophthalmos or Bulging Eye Treated?
Since Exophthalmos or Bulging Eye is a progressive condition it tends to get worse with time and hence it is important for both the patient and the physician to follow the condition closely. The treatment approach for Exopthalmos or Bulging Eye is dependent on a variety of factors like the cause, the age of the patient and the overall health condition of the patient. It is vital for Exophthalmos to be diagnosed early and treated so as to minimize the damage to the eyes. To begin with conservative approaches will be tried. Some of the conservative approaches for treatment of Exophthalmos or Bulging Eye are:
Eyedrops: This is given for people who suffer from dry eyes. This helps to keep the eyes moist and the cornea lubricated preventing it from any injuries.
Eye Glasses: This will be given to people who have photosensitivity.
Steroids: For the pain and inflammation, the patient will be given corticosteroids
Surgery: In case if a tumor is the cause of Exophthalmos or Bulging Eye, then surgery will be recommended to remove the tumor. The patient may be recommended surgery in cases if there is an abnormality in the arteries or veins due to Exophthalmos or Bulging Eyes. In extreme cases of Exophthalmos, the patient may have to undergo removal of floor of the eye socket, a procedure termed as orbital decompression so as to decompress the arteries and veins and treat Exophthalmos or Bulging Eyes.
- American Thyroid Association – “Graves’ Eye Disease (Graves’ Ophthalmopathy)”: https://www.thyroid.org/graves-eye-disease/
- National Institute of Diabetes and Digestive and Kidney Diseases – “Graves’ Disease”: https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease
- MedlinePlus – “Exophthalmos”: https://medlineplus.gov/ency/article/003319.htm
- Cleveland Clinic – “Graves’ Disease”: https://my.clevelandclinic.org/health/diseases/8541-graves-disease
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