The eyes are one of the body’s most complex organs. Working together with the brain, they provide our essential sense of sight. Given how important they are to us, proper eye care is vital. Despite our best efforts, however, eye disease such as glaucoma and cataracts can develop, most often in older adults. Rarely, the eyes may also bulge forward—this is proptosis, and common causes include trauma and disease.
Proptosis or exophthalmos causes abnormal protrusion of the eyeball—that is, the eyes appear to bulge out of the eye socket; depending on the cause, the condition can affect one or both eyes. Instead of being a disorder on its own, proptosis is often a manifestation of another disease. Rarely, the symptom leads to long-term vision problems such as double vision and other complications may also develop over time.
In a healthy individual, the white of the eye is not visible between the iris and the upper eyelid. When it becomes visible, it is usually a sign of abnormal eye bulging. Some of the other symptoms associated with proptosis include discomfort, difficulty closing the eyes fully, blurred vision, pressure behind the eye, drying of the cornea, and difficulty moving the eyes. In some cases, scarring leads to vision loss.
While proptosis occurs in all age groups, it tends to be more common among those over 40. Individuals with a family history of thyroid diseases such as Graves’ disease have a higher risk of developing the issue. People who experience chronic respiratory infections are also more prone to the condition. Participation in contact sports like football or rugby increases the risk of blunt trauma, which can lead to proptosis.
Proptosis is often a sign of an underlying disease. In addition to Graves’ disease—an autoimmune disorder that commonly causes bulging eyes due to swelling and inflammation—proptosis may also result from glaucoma, hyperthyroidism, leukemia, lymphoma, metastatic tumors, and orbital cellulitis. Injuries to the eye, such as those that cause bleeding or hemorrhage, can also lead to the condition.
Sudden onset of proptosis in one eye (unilateral proptosis) is a medical emergency. Should this occur, immediate medical attention is necessary, as it may be a sign of a serious health issue. Possible, serious causes include trauma, orbital tumors, and cancer. At the clinic, the eye doctor will conduct the necessary exams to identify the underlying cause.
Diagnosis typically begins with a thorough look at an individual’s medical history. The physician will then perform a physical exam, during which she will take measurements of the eye using an exophthalmometer—an instrument that helps to determine how far the eye is displaced from the orbital. If the results are out of normal range, she may choose to conduct other tests such as CT or MRI scans, blood tests, and ultrasounds. In some cases, the patient may even require a biopsy.
Not all patients require surgical treatment for proptosis. For instance, a physician may prescribe corticosteroids to help reduce inflammation in the eye. Other non-surgical options include natural tears for eye lubrication and medications that reduce the body’s immune response. Low dose radiotherapy may help in severe cases.
More severe cases of proptosis may require surgery. Orbital decompression—a procedure in which the physician enlarges the orbit of the eye to make room for the tissues and muscles—is one of the most common surgical options. Other treatments include eye muscle surgery and eyelid surgery. A physician may also remove cancerous tumors if they are the cause of the protrusion.
If left untreated, an individual may not be able to close their eyelids properly during sleep—this can dry out the cornea and, over time, increase the risk of ulcers or infection, both of which can cause blindness. Rarely, the protrusion may increase intraocular pressure, which can lead to other eye disorders such as glaucoma. Compression of the optic nerve for long periods raises the risk of severe visual impairment.
Proptosis is often treatable by addressing the underlying cause. For instance, proper treatment of Graves’ disease will help to manage autoimmune-related eye protrusion. If you quit smoking this may also improve health outcomes. As with all conditions, regular follow-ups are important to ensure an individual receives the best possible result.
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