Index
Describes a condition in which the eyeball bulges out of the eye socket, causing it to appear bulky. It can affect one or both eyes.
Depending on how severe it is, exophthalmia can cause eye problems, such as dry cornea and conjunctivitis, which is an inflammation of the lining of the eye.
In the long term, symptoms tend to improve, but this can take years.
Exophthalmia is not a condition but a sign of a disorder. Commonly, it can indicate a problem with the thyroid gland.
Causes of exophthalmia
Graves’ disease is the most common cause of exophthalmia.
Graves disease and thyroid disorders
Graves disease is an autoimmune disease that causes hyperthyroidism. A person with hyperthyroidism has an overactive thyroid gland that produces excess hormones and causes it to grow.
The thyroid is in the neck, below Adam’s apple. The hormones it produces help regulate growth, the speed of metabolism, and other essential functions of the body. The hormones are called thyroxine and triiodothyronine, generally kept in balance.
Thyroid eye disease is a condition in which the soft tissues and muscles around the eyes become swollen and inflamed.
It is often due to hyperthyroidism and sometimes hypothyroidism, caused by an underactive thyroid gland.
Hyperthyroidism or hypothyroidism may not cause the eyes to bulge out right away. It may take some time for this to happen.
In a healthy person, the immune system attacks pathogens, organisms, and substances that are bad for us. These include bacteria, viruses, parasites, cancer cells, and fungi.
However, the immune system begins to attack normal tissue in certain people. This is described as an autoimmune reaction.
Graves’ disease is an example of such an autoimmune reaction. Experts are not sure why autoimmune diseases occur. If a person’s immune system attacks the thyroid gland, it can react by producing additional hormones.
Autoimmune antibodies can attack the muscles and soft tissue around the eyes, which can cause them to bulge out of the sockets.
This can lead to:
- Dry or gritty eyes.
- Redness.
- Swollen eyes.
- Eyesight problems.
Common cause
Graves’ disease is the most common cause of exophthalmia. Between 25 and 50 percent of people with this condition will have ocular involvement.
Interestingly, ocular involvement can occur up to 10 years before the diagnosis of thyroid problems and 20 years after.
The immune cells that attack the thyroid in Graves’ disease also accumulate within the eye socket. Fat tissue and muscles around the eye enlarge, pushing the vision forward and out.
Symptoms
A person who has Graves’ exophthalmia may experience the following symptoms:
- Eye pain.
- Dry eyes.
- Eye irritation.
- Photophobia or sensitivity to light.
- Lacrimation, or eye discharge, and shedding of tears.
- The weakening of the eye muscles causes diplopia or double vision.
- Blurry vision.
- Blindness if the optic nerve is compressed.
- Difficulty moving the eyes, as the eye muscles are affected.
- Pressure behind and around the eyes.
Other signs and symptoms of Graves disease unrelated to the eyes include:
- Irregular heartbeat
- Anxiety .
- High blood pressure.
- Increased appetite
- Weightloss.
- Diarrhea.
- Trouble sleeping
While Graves’ disease is the most common disorder that can cause the eyes to bulge, it is not the only one.
Other causes
Protruding eyes, or a protruding eye, can also occur if something in the eye socket pushes the eyeball forward.
This could be:
- A tumor.
- A blood clot
- An injury to the eye.
- Orbital cellulitis (infection of the tissue around the eye).
- Abnormalities in the brain.
Anyone who notices that one or both eyes are starting to bulge should seek medical attention.
Diagnosis of exophthalmia
A doctor can usually notice a bulging eye when looking at it, but since exophthalmia is typically a sign of some disease or condition, tests will be needed to find the cause.
Tests may include
- A blood test to see if the thyroid gland is working correctly.
- Measurement of the degree of protrusion using an exophthalmometer.
- Imaging scans, such as a CT scan or MRI, examine the eye’s orbit. A scan can detect a tumor or abnormality in or around the eyes.
- A CT scan or MRI of the brain to assess the brain’s structure.
- Exophthalmia tends to be a progressive disease, and symptoms worsen over time. Therefore, treatment should begin as soon as possible.
Treatment
Eye drops can help relieve dry eyes in cases of exophthalmia. The ophthalmologist or eye specialist will monitor the person regularly.
Treatment depends on several factors, including the cause, the person’s age, and general health.
Smoking cessation is recommended for anyone with this condition. Smoking has worsened exophthalmia and made it more challenging to treat.
If the person has thyroid problems, the doctor will treat the underlying cause and restore the thyroid hormone levels to normal.
While treating your thyroid problem is essential, that alone may not resolve exophthalmia. Other treatments often need to be added.
There are a variety of medical options for exophthalmia. Surgery can be helpful for those with more severe eye involvement.
Non-surgical options for treatment may include:
- Natural tears for the lubrication of the eyes.
- Sunglasses for light sensitivity.
- Corticosteroids
- Medications that decrease the immune response, such as cyclosporine.
- Medications that block specific antibodies, such as rituximab (Rituxan).
- Radiotherapy.
In the case of radiation therapy, low-dose radiation treatment is generally reserved for the most severe cases and is often combined with corticosteroids.
Surgical options for treatment may include:
- Orbital decompression: Widening the orbit of the eye can create more space for the eye and its muscles and tissues.
- Eye muscle surgery: This can be done to correct abnormal forces in the eye.
- Eyelid Surgery – Works by protecting the cornea and outer eyeball from damage.
Complications
If left untreated, the eyelids may not close during sleep, causing the cornea to dry out and become damaged. If the cornea becomes too dry, there is a risk of infection or ulcers, impairing vision.
People with exophthalmos are more likely to develop conjunctivitis and upper limbic keratoconjunctivitis, especially in which the upper area of the cornea becomes inflamed due to abnormal tearing and blinking.
