Exophthalmos – types, causes, symptoms, diagnosis, treatment

Proven content

Exophthalmos is one of the main symptoms of orbital ailments. The eyeball then moves forward, sometimes shifting horizontally or vertically. Exopening of the eyes occurs due to an increase in the content of the orbit or due to a decrease in its capacity. Treatment is implemented based on the cause of the ailment.

What is exophthalmia?

Exophthalmos is a condition characterized by the protrusion of the eyeballs (or one eyeball): forwards, to the side, or sometimes upwards because there is no space in the eye socket. This is because tissue grows in the eye socket due to, for example, inflammation or a primary hyperthyroidism (hyperthyroidism). However, there are many possible reasons for the occurrence of exophthalmos. The disease is often accompanied by: reduced eye function, swelling and redness of the eyelids and conjunctiva, sometimes spontaneous pain or pain when moving the eye.

Exophthalmos – types and causes

Bilateral exophthalmia

A common cause of bilateral exophthalmia is ailments related to the thyroid gland. It can attack in a malignant form, leading to a large swelling of the conjunctiva and difficult closing of the eyelids. This condition requires quick consultation with an ophthalmologist and implementation of treatment, as even a short-term regurgitation of the eyelids can lead to severe damage to the cornea.

One-sided exophthalmia

It can occur due to inflammation of the tissues of the orbit. The primary site of infection is most often the eyeball, paranasal sinuses, and the skull cavity. Apart from exophthalmos, there are:

1. edema,
2. redness and pain in the eyelids and conjunctiva,
3. increase in body temperature.

These symptoms should not be ignored as orbital infections can spread rapidly with life-threatening general complications. Therefore, it is necessary to provide medical assistance as soon as possible.

Another cause of unilateral exophthalmia may be benign or malignant neoplasms growing in the eye socket. Growth rates vary – usually faster in malignant tumors. Often the only symptom of a disease beginning is exophthalmos. Later, visual acuity may be impaired as the tumor compresses the optic nerve.

Other factors that cause exophthalmos

Exophthalmos is most often caused by an overactive thyroid gland, but the ailment is also influenced by:

1. skull bone injuries,
2. dilated veins in the eye sockets,
3. angiomas (abnormal blood vessels under the skin or in internal organs)
4. bleeding from the back of the eyeball resulting from an injury
5. glaucoma (pressure of the fluid in the eyeball that damages the optic nerve)
6. myopia (high),
7. cancer of the white blood cells (leukemia),

How does exophthalmia manifest itself?

In patients suffering from exophthalmos, we can observe symptoms in the form of:

1. eye pain
2. protrusion of the eyeball from the eye socket,
3. conjunctivitis,
4. swelling,
5. conjunctival hyperemia,
6. tearing
7. discharge from the eyes
8. limited eye mobility,
9. trouble blinking
10. problems with closing the eyelids completely (and their trembling when closing),
11. progressive loss of vision,
12. double vision,
13. photosensitivity.

Exophthalmos – diagnostics

Exophthalmia is an easy to diagnose during the first meeting with the patient. Then the doctor conducts a medical interview with the patient, which helps him gather information about the time when exophthalmia was noticed; accompanying symptoms and medications taken by the patient. However, it may be a sign of another disease, so it is necessary to establish it. Then the doctors order the following:

1. eye examinations – reveals the degree of exophthalmos in a patient based on his ability to move his eyes; the pressure in the eye and the placement of the eyeballs in the eye socket are measured (exophthalmometry),
2. blood tests – determine how the thyroid gland works (TSH level),
3. magnetic resonance imaging, ultrasound or computed tomography – these types of imaging tests help to identify possible tumors in or within the eyes,
4. examination of the anterior segment of the eye with a slit lamp (then a low magnification microscope and a high intensity light source are used).

The diagnosis of neoplastic disease requires numerous specialist examinations carried out by an ophthalmologist, ENT specialist, radiologist, neurologist and neurosurgeon.

Treatment of exophthalmia

Treatment of exophthalmia depends on the cause that caused it, and because the ailment likes to progress, treatment should be started as soon as possible. When prescribing drugs, the doctor also takes into account the patient’s age and general health. If exophthalmia is caused by problems with the thyroid gland – treatment should be started first. The patients are then administered antithyroid preparations; radioactive iodine and beta-blockers (however, there are situations when it is necessary to remove the thyroid gland). Temporary methods include dropping the eyes with moisturizing preparations, using corticosteroids to reduce inflammation, and wearing sunglasses.

The medications and treatments available on the market are usually effective and restore the appearance of the patient’s eyes to normal. Of course, the effectiveness of treatment is greater if it is implemented early enough, right after exophthalmia occurs. Unfortunately, when there are problems with the connectivity of the arteries and veins in the eyes – surgery is necessary. The situation is similar in patients suffering from a brain tumor.

Important! Exophthalmos should not be ignored, as it can lead to serious complications, both of which are exophthalmos and the underlying disease. If left untreated, the ailment can damage the cornea, and any neoplastic and inflammatory conditions in the orbital area tend to spread rapidly.