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What causes exophthalmos or bulging eyes and what are the treatments?
Exophthalmos or proptosis is the medical term for bulging eyes. One or both eyes can be affected by exophthalmos, and it often gives the appearance of bug eyes. If not treated immediately, there is a small chance that it can permanently affect your vision.
What is Exophthalmos caused by?
Most often, exophthalmos is caused by thyroid eye disease, also known as Graves' ophthalmopathy disease.
Graves' ophthalmopathy disease causes the immune system to attack healthy tissue mistakenly. With thyroid eye disease, the immune system attacks the muscles and fatty tissue surrounding the eyes, causing them to become swollen and bulge.
This autoimmune condition is more common in women and smokers. It affects 1 in every 3 people with an overactive thyroid gland (hyperthyroidism) from Graves' disease. Occasionally thyroid eye disease can affect those with an underactive thyroid gland and sometimes even those with normal thyroid function.
In rare cases, newborn babies can also have the appearance of bug eyes. If you see a baby with big eyes, they may have exophthalmos.
What is bulging eyes a symptom of?
Bulging eyes can also be a symptom of the following:
- Eye injuries
- Infection of the tissue in the eye socket
- Cancerous tumours
- Bleeding behind the eyes
- Glaucoma
Proptosis Vs Exophthalmos
Proptosis, just like exophthalmos, is another medical term to describe bulging eyes.
What is the difference between Exophthalmos and Proptosis?
Proptosis and exophthalmos are both medical terms to describe a swollen eyeball or bulging eyes caused by thyroid eye disease. Exophthalmos will make you look as if your eyeball has popped out. It can also be referred to as thyroid eyes.
Proptosis symptoms
Proptosis symptoms include:
- Pain in the eyes
- Dry eyes
- Eye irritation
- Sensitivity to light
- Double vision
- Blurred vision
- Vision loss
- Pressure behind or around your eyes
- Trouble moving your eyes
- Eye secretions and teary eyes
What causes unilateral proptosis?
Unilateral proptosis is usually caused by tumours and causes only one eye to bulge.
What is bilateral Proptosis?
Bilateral proptosis is when both the eyes are affected, causing them both to bulge. It is often seen in Graves' disease.
Can bulging eyes be corrected?
Bulging eyes can be corrected and in some cases, only requires mild treatment. In more severe cases, surgery may be required to fix bulging eyes. It is essential to understand the cause behind bulging eyes so that the right treatment can be determined.
Diagnosing Exophthalmos
An ophthalmologist (eye specialist) will check a range of things before diagnosing exophthalmos. They may do the following:
- Check your eye movement
- Arrange for an MRI scan or CT scan
- Measure how far your eyeball protrudes using an exophthalmometer
- Organise a blood test to check your thyroid gland
What is the treatment for Exophthalmos?
Treatment options for exophthalmos depend on the cause of the problem. If you suspect that you have exophthalmos, you should see your doctor who will determine the root cause of the eye-bulging.
How do you treat bulging eyes from Graves disease?
If the cause of bulging or protruding eyes is Graves disease, the initial treatment will be to correct your thyroid hormone levels. The right medication can fix these thyroid problems.
There are two phases of thyroid eye disease; therefore, it may require more than one stage of treatment.
The two phases are:
- An active phase (which can last for up to two years) where you risk vision problems and dryness/redness of the eyes is noticeable.
- An inactive phase where the condition has settled down, but you may be left with long-term eye problems such as bulging eyes.
Treating thyroid hormone levels
An overactive or underactive thyroid may be treated with medicine to correct the thyroid hormone levels in your blood.
While treating thyroid hormone levels may not improve your eye-related problems, it can prevent bulging eyes from worsening.
Home treatment and self-care
Your doctor might also recommend the following to relieve symptoms during the active phase of thyroid eye disease:
- Not smoking
- Using extra pillows to raise your head while lying in bed
- Wearing sunglasses if you are also affected by photophobia
- Lubricating your eyes with eye drops
- Avoiding irritants such as dust and dirt
Steroids
In severe cases of exophthalmos, you may need corticosteroids for effective treatment. These steroids will help to control inflammation and stabilise the condition.
Radiotheraphy
If corticosteroids are ineffective, orbital or retrobulbar radiotherapy can be used alone or in conjunction with corticosteroids to destroy cells and reduce swelling.
This type of treatment carries risks such as short-term vision problems, cataracts, and retinopathy.
Surgery
If symptoms of exophthalmos are severe or persistent, one may require surgery. Surgery can be carried out during the active phase, if exophthalmos poses an immediate threat to your vision or in the inactive period, to improve the appearance of bug eyes.
Surgery may also be considered if exophthalmos is caused by other problems, including problems with the blood vessels behind your eyes.
Is Grave's disease hereditary?
It is unclear if Graves’ disease is hereditary, as many genetic and environmental factors can increase the risk of one having the disease. Nevertheless, those who have close relatives with an autoimmune disorder, including Graves’ disease, are more likely to develop it.
Does thyroid eye disease get better?
Symptoms of thyroid eye disease may worsen during the active phase, which can last for up to 2 years; however, thyroid eye disease can get better during the inactive period when the eye settles down. The right treatment can also help thyroid eye disease get better and improve the appearance of bug eyes.
