Summary about Disease
Exophthalmos, also known as proptosis, is the bulging or protrusion of one or both eyeballs out of the eye socket. It's most commonly associated with thyroid eye disease, specifically Graves' disease. In this condition, the tissues behind the eye swell, pushing the eyeball forward. The severity can vary from mild to severe, affecting vision and eye comfort.
Symptoms
Bulging of one or both eyes
Dry, gritty, or irritated eyes
Double vision
Difficulty closing the eyelids completely
Increased tearing
Pain or pressure in the eyes
Redness or inflammation of the eyes
Blurred vision or impaired vision
Sensitivity to light
Causes
The most common cause is thyroid eye disease, particularly Graves' disease, an autoimmune disorder where the immune system attacks the thyroid gland and the tissues around the eyes. Other less common causes include:
Orbital tumors
Orbital cellulitis (infection of the eye socket)
Orbital hemorrhage (bleeding in the eye socket)
Vascular malformations
Inflammatory conditions
Medicine Used
Treatment depends on the underlying cause and severity. For thyroid eye disease:
Corticosteroids: To reduce inflammation.
Teprotumumab (Tepezza): An antibody medication specifically for thyroid eye disease to reduce eye bulging.
Artificial tears and lubricating ointments: To relieve dry eye symptoms.
Selenium supplements: May help in mild cases.
Immunosuppressants: To suppress the immune system in severe cases.
Thyroid medication: To manage thyroid hormone levels (if the underlying cause is thyroid related). In cases not related to thyroid issues, the medications will target the specific underlying cause such as antibiotics for orbital cellulitis or surgery for tumors.
Is Communicable
Exophthalmos itself is not communicable. It's a symptom of an underlying condition, and the underlying conditions (like Graves' disease or orbital tumors) are typically not contagious. Orbital cellulitis, caused by bacteria, is technically an infection but not easily spread person-to-person.
Precautions
Regular eye exams: To monitor the condition and detect any changes early.
Manage underlying conditions: Control thyroid hormone levels if thyroid eye disease is the cause.
Protect your eyes: Wear sunglasses to protect against light sensitivity and use artificial tears to keep eyes moist.
Elevate your head: Sleep with your head elevated to reduce swelling around the eyes.
Quit smoking: Smoking can worsen thyroid eye disease.
How long does an outbreak last?
The duration of exophthalmos depends entirely on the underlying cause and how effectively it's treated.
Thyroid eye disease: The active inflammatory phase can last for several months to a few years. After the active phase, some degree of proptosis may remain permanently. Treatment can shorten the active phase and reduce the severity of the proptosis.
Other causes: The duration will vary significantly depending on the specific condition and its treatment. For example, proptosis due to an infection might resolve within weeks with appropriate antibiotic treatment.
How is it diagnosed?
Physical examination: Assessing the degree of proptosis, eye movement, and eyelid closure.
Exophthalmometry: Measuring the degree of proptosis using an instrument called an exophthalmometer.
Blood tests: To check thyroid hormone levels (T3, T4, TSH) and thyroid antibodies if thyroid eye disease is suspected.
Imaging studies: CT scan or MRI of the orbits to visualize the eye muscles, fat, and other structures, to rule out tumors, inflammation, or other abnormalities.
Visual field testing: To assess peripheral vision.
Forced duction testing: To evaluate eye muscle movement and restrictions.
Timeline of Symptoms
The timeline of symptoms varies depending on the underlying cause. For thyroid eye disease, the timeline is generally:
Early stage: Mild eye irritation, dryness, and subtle proptosis.
Active phase: Increased inflammation, redness, swelling, and worsening proptosis. Double vision may develop. This phase can last months to years.
Inactive phase: Inflammation subsides, but some degree of proptosis and eye muscle restriction may remain. Vision may be permanently affected. For other causes, such as infection or tumor, the onset and progression of symptoms can be more rapid.
Important Considerations
Early diagnosis and treatment are crucial: Especially for thyroid eye disease, as early intervention can help minimize long-term complications and vision loss.
Multidisciplinary approach: Management often involves an ophthalmologist, endocrinologist, and potentially other specialists depending on the underlying cause.
Psychological impact: Exophthalmos can significantly affect appearance and self-esteem. Support groups and counseling can be beneficial.
Surgery: In severe cases, surgery may be necessary to decompress the orbit, correct eyelid retraction, or address double vision.