Exophthalmos

Exophthalmos

What is exophthalmos?

It is the projection or bulging of the eyeball outwards (proptosis), which may give the impression of "bulging eyes". This may affect one eye or both, depending on the causes.

What causes it?

In a high percentage of cases, exophthalmos is associated with thyroid orbitopathy, an inflammatory disease related to hyperthyroidism.

The disease may be very serious, since the orbit is a non-extensible osseous cavity, in which an inflammatory process such as this can compress the optic nerve and cause blindness.

Other processes, which may cause exophthalmos, are orbital tumours, a large eyeball, high myopia or congenital glaucoma, as well as other thyroid or inflammatory orbital diseases.

El hipertiroidismo puede provocar exoftalmos Hyperthyroidism can cause exophthalmos

How can it be prevented?

In some cases, in its initial stages, exophthalmos can only be detected using imaging techniques.

Patients with hyperthyroidism problems should see an ophthalmologist, since the visual organ is a target for diseases related to hyperthyroidism.

Even today, if the associated eye problem is not obvious, the endocrinologist may not refer the patient to a specialist ophthalmologist.

However, statistics show that diseases associated with exophthalmos, such as thyroid orbitopathy, occur particularly in young women and smokers. It has been proven that tobacco, although not a direct trigger, aggravates these diseases, so it is important to avoid it.

Patients may present:

  • Upper eyelid retraction, which gives the face a look of shock or surprise.
  • Ocular irritation and reddening of the orbital and conjunctival tissues.
  • In inflammatory cases, such as thyroid orbitopathy, the exophthalmos may be accompanied by strabismus (deviation of an eye) and diplopia (double vision). This is due to thickening of the extraocular muscles, as well as a significant loss of vision due to compression of the optic nerve.
El hipertiroidismo puede provocar exoftalmos Patient with exophthalmos
El hipertiroidismo puede provocar exoftalmos In some cases, exophthalmos is accompanied              by diplopia

Depending on the causes, the evolution and the prognosis of each patient, there are different strategies for treating exophthalmos:

  • Protective measures to combat the symptoms. Use of artificial drops, sunglasses when out on the street or sleeping with your head raised to avoid the accumulation of fluid in the eye.
  • Medical treatment. With corticosteroids and/or immunosuppressants.
  • Surgical treatment. This is necessary when there is a serious compromise in visual acuity due to the optic nerve. The main surgery focuses on decompression of the orbit, with the aim of increasing its capacity. If there is double vision, after a while, this surgery may be complemented with surgery of the retro-ocular muscles. Current orbital surgery addresses the ocular, aesthetic and functional problems in patients with orbital problems, such as exophthalmos, and recovers the vision, if this has been affected, as long as action was taken in time.

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