What is exophthalmos? Symptoms, causes & treatment

Exophthalmos refers to a medical condition that manifests as an abnormal bulging or protuberance of the eye. It is a noticeable and often disconcerting symptom stemming from an underlying illness. Most often associated with Graves' disease, an autoimmune disorder that leads to overactivity of the thyroid (hyperthyroidism), exophthalmos can also be caused by other health issues such as tumours, infections or other thyroid diseases.

In clinical terms, exophthalmos is defined by the enhanced anteroposterior positioning of the eyeball, leading to protrusion beyond the orbit's protective bony structure. This condition, often referred to as bulging eyes or proptosis, can affect one or both eyes. It's worth noting that exophthalmos is not a disease but a physical sign of an underlying condition that warrants immediate medical attention.

 

The symptoms associated with exophthalmos include a prominent bulging of the eyes, accompanied by dryness, irritation, discomfort, or pain in the eyes. There might also be excessive tearing or difficulty in closing the eyes completely. The patient may experience redness, swelling, a sensation of pressure, or a gritty feeling in the eyes. Depending on the underlying cause, individuals may also display signs such as increased sensitivity to light, double vision, or vision loss.

What is exophthalmos caused by?

Besides being a predominant sign of Graves' disease, exophthalmos can also arise due to several other health conditions. Tumours in the orbit, cysts, or an overproduction of cells in the orbit due to an inflammatory disease are plausible causes. A rare cause could be chronic sinusitis, where the prolonged inflammation causes an accumulation of fluid, leading to the bulging of eyes.

The most immediate concern of exophthalmos isn't aesthetic but functional, as it threatens the individual's visual capacity. Therefore, treatment of exophthalmos primarily targets the underlying cause of the symptom. However, in the interim, addressing the discomfort and safeguarding the exposed cornea becomes equally essential.

For the treatment of the underlying diseases that cause exophthalmos, various methodologies like medications, radiation, or surgeries can be considered. For example, in the case of Graves’ disease, treatment could include antithyroid medications or radioiodine therapy to regulate or reduce the overactive thyroid. Surgery might be an option when there's a tumour in the orbit that needs to be extracted. In some cases, an orbital decompression may also be performed, where the surgeon removes a part of the bone from the walls of the eye socket to create more space.

 

Along with these, to manage the immediate physical distress of exophthalmos, patients might be prescribed artificial tears to relieve dryness and irritation. Wearing sunglasses can help reduce light sensitivity, and using eye ointments at night can protect the exposed cornea. In some cases, the use of prisms might be recommended to counter double vision. The patients are often advised to sleep with an elevated head to reduce swelling.

 

To sum up, exophthalmos is not a medical disorder on its own but a symptom of an underlying condition that needs to be addressed. Nonetheless, the immediate discomfort it causes necessitates individual management techniques even as the root cause is being treated. However, with timely detection and proper treatment, patients finally can expect a significant improvement in their symptoms and long-term outcomes.