Exophthalmos

What is exophthalmos (bulging eyes)?

Exophthalmos is the term used to describe bulging eyes; eyes that protrude from their normal position. It is also known as proptosis. Most often, this can be a sign of a potentially serious underlying medical condition, such as hyperthyroidism.

Generally, protruding eyes are considered protruding eyes if the whites of the eyes are visible between the iris (the colored part of the eye) and the upper eyelid. The sudden bulging should be treated as an emergency.

Exophthalmos prognosis

If the bulge occurs suddenly, there is a small risk that the optic nerve is compressed by the pressure caused by exophthalmos and therefore, without prompt treatment, vision may be impaired.

However, if symptoms of thyroid disease are present, exophthalmos may diminish with time and treatment. Sometimes, corrective surgery will be necessary to prevent the eyes from bulging permanently.

In some cases of exophthalmos, patients are left with long-term vision problems, such as double vision, but permanent problems are rare.

This eye condition is a symptom of a thyroid problem, such as hyperthyroidism.

Symptoms of exophthalmos

Exophthalmos is the outward bulging of the eyes. If it is a symptom of an underlying condition, you may have other symptoms of this condition.

Medical tests to diagnose exophthalmos

If your eyes begin to bulge, either both eyes or just one eye, you need to see a doctor. The doctor will want a complete medical history and will perform a physical examination. Additional tests will be performed to determine the underlying cause of exophthalmos, including a vision test, CT scan or MRI, and blood tests.

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What are the causes of exophthalmos?

The most common cause of exophthalmos is hyperthyroidism (an overactive thyroid gland). This gland is located in the neck and is responsible for releasing hormones that help control metabolism. Therefore, with hyperthyroidism, too many of these hormones are released.

Another common cause of bulging eyes is Grave’s disease, which is an autoimmune disorder that causes hyperthyroidism.

Other causes of exophthalmos include:

  • Certain cancers (leukemia, neuroblastoma, lymphoma).
  • Hemangioma (an abnormal buildup of blood vessels)
  • Injury to the eye
  • Eye infections
  • Sarcoidosis

Treatments for exophthalmos

Treatment will depend on the underlying cause of the exophthalmos, but may include eye drops, antibiotics or surgery. If hyperthyroidism or Grave’s disease is diagnosed, then you will be treated for these conditions, either with medication, surgery or hormone therapy.

If the underlying cause is cancer, then surgery, radiation therapy or chemotherapy will be recommended; however, you will need to see a cancer specialist. Surgery may involve the following:

  • Eyelid surgery: to improve the closure and appearance of the eyelids.
  • Eye muscle surgery: aligns the eyes and reduces double vision.
  • Orbital decompression surgery: small sections of bone are removed from the eye socket.

What type of specialist treats exophthalmos?

Depending on the underlying cause, different specialists will treat exophthalmos. However, it will likely be treated with a multidisciplinary team that includes ophthalmologists, surgeons, endocrinologists, and oncologists.