Exophthalmos, also known as Proptosis, refers to a protrusion or bulging of one (unilateral) or both (bilateral) the eyeballs out of the orbit. Exophthalmos is not a medical condition in itself; but a sign or a symptom of some other disease. There are many underlying conditions that can result in exophthalmos, but most often it is caused by thyroid- related conditions such as Graves disease. Graves disease induced Exophthalmos is one of the manifestations of thyroid eye problems.
Exophthalmos caused due to Graves' disease is usually bilateral. Apart from thyroid problems, there are other conditions that may lead to Exophthalmos. They include cancerous tumor, Mucocoele (mucus-filled cyst), blood clot, trauma (eye injury), inflammation of the orbit structures and very rarely Retrobulbar hemorrhage (bleeding in the eye socket).
Signs and symptoms of Exophthalmos
Exophthalmos caused by Graves disease normally produces symptoms such as pain, watering, dryness, irritation, sensitivity to light, double vision and loss of vision. Tumor-induced exophthalmos presents itself with severe eye pain, headaches and double vision.
Diagnosis of Exophthalmos
Exophthalmos is easily noticeable by its appearance during clinical examination. Ophthalmologist uses exophthalmometer to measure the degree of bulging or protrusion. Blood tests are normally advised, if doctor suspects hypothyroidism, to evaluate thyroid gland function.
If the bulging has occurred in one eye, MRI or CT scan is done to rule out the presence of tumor. These tests also help in diagnosing Orbital cellulitis and Retrobulbar hemorrhage.
Treatment of Exophthalmos
Treating the exophthalmos at an early stage is essential as it is a progressive disease and if left untreated patient may be unable to close the eyes totally. This may dry out the cornea leading to infections and ulcers eventually resulting in vision loss.
In case of thyroid related exophthalmos, the aim of the treatment is to restore the thyroid function and bring the thyroid hormones to normal levels. Medications such as thionamides and radio iodine are given orally to treat overactive thyroid gland. In severe cases, corticosteroids are also administered to provide relief from pain and inflammation. Lubricants are also prescribed to treat dry, red and sore eyes. If the exophthalmos is caused by a tumor, treatments such as radiotherapy, chemotherapy and surgery may be appropriate.
The conjunctiva is the thin, transparent tissue that lines the eyelids and surface of the eye. The swelling of conjunctiva is termed as chemosis. The swelling is due to accumulation of fluid. Due to the swelling, the eyes cannot close properly and affects visual acuity. Chemosis is alternatively referred to as fluid-filled conjunctiva, swollen eye or conjunctiva.
The most common symptom associated with chemosis is swelling of the eye and the eye appearing red in color. In most of the cases, chemosis is caused by an allergic reaction, viral infection as well as by rubbing of the eye. Exophthalmos, a sign of hyperthyroidism, which results in abnormal bulging of one or both eyes, may also be associated with Chemosis.
Treatment of chemosis depends on its cause. Home care treatment options of chemosis due to angioedema or allergies includes using over-the-counter antihistmine medications and placing cool clothes on the eyes. It is best to contact health care provider in case the symptoms continue. The health care provider may diagnose by conducting a physical examination of the eye. Certain questions to understand the history of swelling of the eye and discomfort it causes will be asked. The health care provider will then prescribe an eye cream to reduce the swelling and antibiotics medications.
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Bibliography / Reference
Collection of Pages - Last revised Date: October 27, 2020