EXOPHTHALMOS (PROTRUSION OF THE EYES; ALSO KNOWN AS EXOPHTHALMIA OR PROPTOSIS): CAUSES, TREATMENT AND MANAGEMENT

OVERVIEW

 Exophthalmos is a condition in which the eyeball(s) protrudes anteriorly out of the eye socket. It could be either bilateral (when both eyes bulge out as in Grave’s disease) or unilateral (when just one eye bulges out). It is also known as Exophthalmia or Proptosis. Causes of exophthalmos include: Hyperthyroidism, grave's disease, "something" or an enlargement (tumour) in the eye and hereditary. Exophthalmos is usually the sign of an undelying health issues so its treatment focuses on resolving them. Treatment and management of exophthalmos include: treating thyroid problems, administering corticosteroids and eye drops to alleviate painful eye inflammation and moisten the eyes respectively, using eye shades in cases of photophobia and surgery to remove large tumours in the eye

EXOPHTHALMOS

If left untreated, exophthalmos can become so severe that the eyelids may fail to close during sleep. This results to dryness and damage of the cornea and subsequent loss of sight. The major sign of exophthalmos is the protrusion of the eyeballs

CAUSES

Conditions that affect the thyroid gland are the major causes of exophthalmos. The thyroid gland is a small gland located at the base of the throat, just in front of the trachea, that controls the body metabolism through the secretion of 2 major hormones. A thyroid condition that affects the eyes is known as Thyroid eye disease or thyroid orbitopathy, and mostly affects both eyes

Causes of Exophthalmos are:

• An overactive thyroid gland (Hyperthyroidism): This is the over-production of thyroid hormones by the thyroid gland. It leads to puffy, swollen eyes and bulging eyeballs

• Grave’s disease: This is an autoimmune disease that occurs when a person’s immune system attacks the thyroid gland, which then reacts by producing more hormones than usual. These excess thyroid hormones (and sometimes together with the autoimmune antibodies) may even proceed to attack the muscles and soft tissues surrounding the eyes. It could be Grave’s disease when you begin to notice signs and symptoms such as dry (or gritty)eyes, red and puffy eyes, photophobia (sensitivity to light) and diplopia (double vision)

• Proptosis: This is not related to the thyroid gland per se. Usually, the eye orbit or socket is not expandable and is closed off at the back and both sides, so any enlargement of structures within it will cause the eyeball to protrude. This is exactly what happens in proptosis. “Something” either enlarges or is wrongly found in the eye. These could be:
  
  • Swelling or enlargement of the tear glands
  • Cancerous tumours
  • Mucus-filled cysts (mucocoele)
  • Blood clot
  • Eye injury
  • Sinus infection
  • Brain tumour

• An underactive thyroid gland could also cause exophthalmos

• Hereditary: Exophthalmos can be passed on from parents to children

Contrary to expectations, exophthalmos does not always occur at the same time with thyroid gland problems such as hyperthyroidism or hypothyroidism. It may occur months or sometimes years afterwards. In some cases, it may even occur before the thyroid problems develop

TREATMENT AND MANAGEMENT

Exophthalmos is a progressive disease and tends to worsen over time. For successful and effective treatment procedures, report to your doctor as soon as you notice any swelling in your eye. Its treatment involves tackling the underlying cause and managing its signs and symptoms

Treatment options includes:

• Treating thyroid problems: If it is due to  hyperthyroidism, then effective steps has to be taken to stop the excessive production of thyroid hormones. This is achieved by the use of medications such as administering thionamides or radioiodine treatment (where a chemical known as radioactive iodine is swallowed) all of which aims at shrinking the thyroid gland and bringing the thyroid hormone levels back to normal

• If the eyes are swollen and painful (inflammed), the person will be administered with corticosteroids to help reduce painful eye inflammation

• If the eyes are dry, eye-drops or lubricants may be used to moisten the eyes and relieve irritation

• If the person experiences photophobia, eye shades or goggles may be used

• Sometimes, surgery may be required to either enlarge the eye sockets or remove large tumours in the eye (in cases of extreme proptosis)

Pain, redness and swelling of the eyes do not go away immediately after treatment. It takes a few months or even longer. If the exophthalmos was as a result of a thyroid eye disease, the eyes may not go back to normal even after treatment.

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