Exophthalmos – Causes, Symptoms, and Treatment

Exophthalmos is a protrusion of the eyeball because it is related to hormones (usually hyperthyroidism). The word exophthalmus comes from the Greek word meaning protruding eyes. This can occur in one or both eyes.

Often exophthalmus is equated with the term proptosis. Although both of these conditions are both prominent eyeballs, the proptosis is protrusion of the eyeball due to different causes.

In adults, tiorid orbitopathy is the most common cause of exophthalmus. In children, unilateral exophthalmus (one eye) is often caused by orbital cellulitis in which the most common cause is neuroblastoma. While bilateral exophthalmus (two eyes) is a condition that is usually caused by leukemia.

Causes of Exophthalmus

The causes of exoftalmos can vary, including:

  • Thyroid disorders or thyroid disorders called Grave Disease or Grave Ophthalmopathy. Protrusion occurs to the two eyeballs because there is swelling (hypertrophy) of the eyeball moving muscles so that it pushes the eyeballs forward.
  • Vascular disorders, such as cavernous sinus thrombosis
  • Tumors in the eye socket
  • Bleeding behind the eyes
  • Inflammation around the eyeball
  • Pseudotumor

To note, bulging eyes in children can occur more easily than adults because the eyeball is more flexible and the size of the orbit of the eyeball is smaller. Meanwhile, the cause of protruding eyes in children is also different because it must be suspected of cancer or tumors in the eyeball.

Symptoms of Exophthalmus

Common symptoms that occur are one or both of the eyeballs appear protruding and there is an increase in pressure in the eye socket. This pressure can affect the optic nerve, which ultimately interferes with vision. Here are other common symptoms that may occur:

  • The eyelid swells. This may be related to conjunctival chemosis (the conjunctiva looks red and bulging, often under the eyeball).
  • Double vision. This is caused by limitation of extraocular muscles. This restriction may be a source of inflammation (myositis) or pressure from the tumor.
  • Red eye. In severe cases, there may be secondary keratopathy as a result of eye closure that is not total so that there are parts of the eye that are dry and become keratopathy.

In addition, visual acuity may decrease due to:

  • Direct optic nerve involvement due to disease pathophysiology.
  • Distortion of the macula by lesions that push the back of the eyeball.
  • Exposure to keratopathy.
  • The optic nerve that runs before the eyes.

Diagnosis of Exophthalmus

Not all people with protruding eyes experience exophthalmus. Some people have protruding eyes, where the whites are more visible than people in general. There is a device called an exophthalmometer that can measure the protrusion. In addition, CT scan or MRI examination can also play a role in examining orbital bone components.

Treatment of Exophthalmus

If there is a tumor growing behind the eye, the tumor needs to be taken. If the cause is Graves’ disease, the possibility of treatment is to overcome an overactive hyperthyroid condition. Keeping the front of the eye moist is also necessary if the eyelids cannot close.

Meanwhile, if hormonal treatment has been completed or has been declared normal, but the eyeball remains protruding, it is caused due to muscle damage (muscle hypretrophy). Therefore, surgery is needed by reducing muscle volume.

Another way you can try to deal with exophthalmus is to give anti-inflammatory drugs to reduce swelling. Until now, there has been no way to prevent exophthalmus unless it prevents the underlying cause.

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