Exophthalmos refers to a protrusion of the eyeball, which exits the orbits beyond the eyelid rima. It is also known by the term proptosis or the more common expression ‘eyes out’, although exophthalmos is usually associated with endocrine-related alterations

The eye is positioned in the orbit, which is formed by bony walls that cannot, in normal situations, deform.

This is why it is usually an increase in the volume of the orbital contents that shifts the position of the eye.

The latter is in fact generated by a number of variables, such as eye size, orbit volume, extra-orbital muscles and retro-orbital fat.

If one of these variables is altered, the eye protrudes forward, resulting in exophthalmos.

Exophthalmos can be distinguished into two types:

• direct, when the eye is pushed forward
• indirect, when the eyeball is also moved laterally

Symptoms of exophthalmos

Usually one eye out is visible, although in the early stages, i.e. in the presence of mild exophthalmos, the disorder may not give any symptoms.

When the protusion is significant, however, the consequence is a misalignment that gives rise to diplopia.

If the eye is then so far forward that it cannot be completely covered by the eyelid, the patient may present with exposure keratitis.

A condition that could cause severe damage to the cornea and conjunctiva, up to and including ulcerations that impair vision and cause severe pain.

Ultimately, symptoms that should prompt an urgent visit to an ophthalmologist include:

• reddening of the eyes
• pain
• diplopia
• headache
• visual deficits
• fever
• pulsating proptosis

Exophthalmos: main causes

The causes of exophthalmos can be diverse and not all related to the visual apparatus.

In some cases, as we said, the origin lies in endocrine system issues.

In any case, the overeye is always caused by an increase in volume of the orbital contents, but this can have different origins.

Among the most common causes that can give rise to exophthalmos are:

• hyperthyroidism (in particular Graves’ disease – Basedow)
• tumours, with the presence of a mass in the orbital cavity
• inflammation, when physical, infectious or traumatic causes cause oedema that ‘pushes’ on the eye
• vascular changes, such as carotid-carvernous fistula, which causes pulsatility

Other causes of proptosis may be

• progeria, a rare genetic disease that causes premature and progressive ageing of the body, already present in childhood
• infectious cellulitis, an inflammation of the skin and subcutaneous tissue caused by bacterial infection, a primary cause of exophthalmos in children
• glaucoma, an eye disease caused by increased eye pressure
• dacryocystitis, an inflammation of the lacrimal sac often caused by an infection with streptococci or staphylococci
• leukaemia
• meningioma, a type of brain tumour
• neuroblastoma, a malignant tumour that particularly affects children
• spherocytosis, a hereditary form of chronic haemolytic anaemia
• vitiligo, a skin disease in which the body does not produce or produces low amounts of melanin
• Cushing’s disease, a disease caused by excessive pituitary production of adrenocorticotropic hormone
• severe obesity

How exophthalmos is diagnosed

The first thing to do when you have one or more symptoms related to exophthalmos is to book an eye examination to check with the specialist whether or not you have proptosis.

The first step is a careful anamnesis, followed by a general eye examination in which the direction of proptosis, its unilaterality or bilaterality, any other defects such as strabismus, ptosis or abnormalities of the eyelid or conjunctiva are assessed.

The doctor then performs exophthalmometry, a test that measures the distance between the lateral angle of the orbital bone and the cornea using a special instrument called a Hertel exophthalmometer.

The ophthalmologist will also palpate the orbital rim looking for any masses, and will complete with a visual acuity check, an eye motility assessment and a fundus test.

Ocular ultrasound can also prove to be a valuable aid in assessing the state of the extraocular muscles and orbital soft tissues.

In addition, the specialist can use computed tomography of the eye, a diagnostic imaging test that allows a more precise analysis of the internal structures of the eye and the tissues present in the orbital cavity.

Magnetic resonance imaging can also be useful in understanding not only whether one has proptosis, but also what causes it.

These tests are particularly good for ruling out tumours, trauma, vascular pathologies and other disorders that can cause an increase in the orbital cavity content.

If they do not show anything, the state of the thyroid gland will be assessed to look for any imbalances.

Care and treatment of exophthalmos

The treatment of protruding eyes depends on the origin of the proptosis itself.

It is therefore necessary to identify the origin of the problem: in some cases, such as in the presence of tumours or infections, it is sufficient to resolve the cause to see the exophthalmos recede.

Other times, however, especially if the proptosis is linked to hereditary or endocrine disorders, it cannot always be completely resolved but only treated.

When the eye is completely uncovered, in order to avoid exposure keratitis and damage to the cornea or conjunctiva, lubrication with artificial tears is carried out.

When exposure keratitis is already present, antibiotic treatment is usually carried out to avoid infection.

In some cases, surgery may be necessary to at least partially remedy the exposure of the cornea by covering it.

Usually an orbital decompression is performed, increasing the volume of the orbit.

The latter is particularly useful when one is faced with thyroid pathology, but also when exophthalmos causes damage to the optic nerve that could lead to irreversible loss of vision.

Exophthalmos, or proptosis, is also called eye out precisely because it consists of the eyeballs protruding forward.

It can be caused by diseases, trauma, tumours, infections or endocrine disorders, and cannot always be completely resolved.

Read Also

Emergency Live Even More…Live: Download The New Free App Of Your Newspaper For IOS And Android

Hemianopsia: What It Is, Disease, Symptoms, Treatment

Colour Blindness: What Is It?

Diseases Of The Ocular Conjunctiva: What Are Pinguecula And Pterygium And How To Treat Them

What Is Ocular Pterygium And When Surgery Is Necessary

Vitreous Detachment: What It Is, What Consequences It Has

Macular Degeneration: What It Is, Symptoms, Causes, Treatment

Conjunctivitis: What It Is, Symptoms And Treatment

How To Cure Allergic Conjunctivitis And Reduce Clinical Signs: The Tacrolimus Study

Bacterial Conjunctivitis: How To Manage This Very Contagious Disease

Allergic Conjunctivitis: An Overview Of This Eye Infection

Keratoconjunctivitis: Symptoms, Diagnosis And Treatment Of This Inflammation Of The Eye

Keratitis: What Is It?

Glaucoma: What Is True And What Is False?

Eye Health: Prevent Conjunctivitis, Blepharitis, Chalazions And Allergies With Eye Wipes

What Is Ocular Tonometry And When Should It Be Done?

Dry Eye Syndrome: How To Protect Your Eyes From PC Exposure

Autoimmune Diseases: The Sand In The Eyes Of Sjögren’s Syndrome

Dry Eye Syndrome: Symptoms, Causes And Remedies

How To Prevent Dry Eyes During Winter: Tips

Blepharitis: The Inflammation Of The Eyelids

Blepharitis: What Is It And What Are The Most Common Symptoms?

Stye, An Eye Inflammation That Affects Young And Old Alike

Diplopia: Forms, Causes And Treatment

Source

Pagine Bianche