Everything you need to know about exophthalmos

Exophthalmos defines a disorder in which the eyeball protrudes from the socket of the eye, thereby making it appear to be bulging. This has the ability to damage one or both eyes.

Exophthalmos can cause eye problems, such as corneal dryness and conjunctivitis, which is an inflammation of the membrane lining the eye, depending on how serious this is.

Symptoms continue to improve in the long term but that can take years. There’s a chance that if care is not provided, the eyes can start to bulge.

Exophthalmos is a symptom of a disorder, not a condition. Commonly, this may indicate a thyroid gland problem. The most severe condition of Graves is the most common cause of exophthalmos.

Graves’ disease and thyroid disorders

Graves’ disease affects the thyroid gland.
Graves’ disease affects the thyroid gland.

Disease of Graves is an autoimmune disease which causes hyperthyroidism. A person with hyperthyroidism has an overactive thyroid gland that produces and causes the excess hormones to rise.

The thyroid lies in the heart, under the apple of Adam. The hormones that it produces help control growth, metabolism rate and other important body functions. The hormones are called thyroxine and triiodothyronine, and usually kept in balance.

Thyroid eye disease is a disorder in which the soft tissues and muscles around the eyes swell and become inflamed.

This sometimes stems from hyperthyroidism, and often from hypothyroidism, triggered by an underactive thyroid gland.

Hyperthyroidism or hypothyroidism can not necessarily cause the eyes to wallow. It could take some time to happen.

The immune system fights bacteria, the organisms and the chemicals which are bad for us in a healthy person. Which involve other bacteria , viruses , parasites, cancer cells, fungi, etc. For certain cases, however, the immune system starts destroying normal tissue. They describe this as an autoimmune reaction.

The disease of Graves is an example of the autoimmune reaction. Experts aren’t sure what causes autoimmune diseases. When an individual’s immune system attacks the thyroid gland, it may respond with the development of extra hormones.

The autoimmune antibodies will invade the muscles and soft tissue around the eyes which can cause them to protrude from the sockets.

This can lead to:

  • dry or gritty eyes
  • redness
  • puffy eyes
  • inflammation and swelling
  • vision problems

Common cause

Exophthalmos is a symptom of Graves’ disease.
Exophthalmos is a symptom of Graves’ disease.

The most common cause of the exophthalmos is the disease of Graves. Anywhere from 25-50 per cent of people with this disorder would be active in the eye.

Interestingly, eye involvement can occur up to 10 years before thyroid disorders are detected, and up to 20 years afterwards. During Graves’ disease the immune cells that invade the thyroid also accumulate inside the eye socket. The fatty tissue and muscles around the eye get high, moving the eye forward and outwards.

Symptoms

A person who has Graves’ exophthalmos may experience the following symptoms:

  • pain in the eyes
  • dry eyes
  • eye irritation
  • photophobia, or sensitivity to light
  • lacrimation, or eye secretions, and shedding of tears
  • diplopia, or double vision caused by weakening of the eye muscles
  • blurred vision
  • blindness if the optic nerve is compressed
  • difficulty in moving eyes, as the eye muscles are affected
  • feeling pressure behind and around the eyes

Many non-eye-related signs and symptoms of Graves’ disease include irregular heartbeats, anxiety, high blood pressure, excessive appetite, weight loss, vomiting, and sleep issues.

While Graves ‘ disease is the most common condition that can protrude the eyes, it is not the only one.

Other causes

It may also happen to protruding eyes, or a protruding eye, if there is anything in the eye socket that forces the eyeball forward. This could be:

  • a cancerous or non-cancerous tumor
  • a blood clot
  • an eye injury
  • orbital cellulitis (infection of tissue around the eye)
  • abnormalities within the brain

Anybody who notices that one or both eyes are starting to bulge should seek medical attention.

Diagnosis

A doctor can usually note a protruding eye by looking at it, but because exophthalmos is usually a sign of some disease or disorder, tests may be required to determine the cause.

Tests may include:

  • A blood test to see if the thyroid gland is functioning properly.
  • Measurement of the degree of protrusion, using an exophthalmometer.
  • Imaging scans, such as a CT scan or an MRI, to examine the orbit, or eye socket. A scan can detect a tumor or any abnormality in or around the eyes.
  • A CT scan or MRI of the brain to evaluate the structure of the brain.

Exophthalmos appears to be a progressive disease and over time, the symptoms get worse. So treatment should start as soon as possible.

Treatment

Eye drops may help relieve dry eyes in cases of exophthalmos.
Eye drops may help relieve dry eyes in cases of exophthalmos.

The ophthalmologist or eye-specialist will periodically examine the individual.

Treatment depends on many factors including the origin, age of the individual and general health of the person.

It’s recommended that someone with this disorder stop smoking. Smoking has been shown to worsen the exophthalmos and make treatment more difficult.

If the person has thyroid problems, the doctor will treat the root cause and restore the levels of thyroid hormone to normal. While it is necessary to treat the thyroid problem, that the exophthalmos may not be resolved by itself. Other therapies also need to be replaced.

The exophthalmos have a variety of medical choices. Surgery can be helpful for those with a more serious involvement of the eyes.

Treatment options which are not surgical can include:

  • natural tears for eye lubrication
  • sunglasses for light sensitivity
  • corticosteroids
  • medications that decrease the immune response, such as cyclosporin
  • medications that block certain antibodies, such as rituximab (Rituxan)
  • radiotherapy

In radiotherapy, diagnosis with low dose radiation is usually reserved for more severe cases, and is often merged with corticosteroids.

Surgical options for treatment can include:

  • Orbital decompression: Enlarging the orbit of the eye can make more room for the eye and its muscle and tissue.
  • Eye muscle surgery: This can be done to correct abnormal eye muscles.
  • Eyelid surgery: This works by protecting the cornea and outer eyeball from damage.

Complications

The eyelids that fail to close during sleep if left untreated, resulting in drying of the cornea and becoming damage. There is a chance of infection or ulcers if the cornea dries out too soon, which can impair vision.

People with exophthalmos are more likely to develop conjunctivitis, and especially superior limbic keratoconjunctivitis, in which the region above the cornea is inflamed due to irregular tearing and blinking.

Rarely, some people may experience optic nerve or ophthalmic artery compression which may ultimately impair their eyesight and may lead to blindness.

Outlook

In general, finding medical attention is the first step for any person who sees bulging eyes. Know, exophthalmos is a warning that something is happening in, around, or inside the brain.

Graves ‘ disease is the most prevalent cause of exophthalmos. It is important to work closely with the medical team to establish a treatment plan for treating all thyroid issues, along with any complications of the eyes. Quitting smoking is crucial to improving exophthalmos results, while better follow-up would ensure the best possible treatment.

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