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Exophthalmos and Its Pathophysiology

The protruding or bulging of the eyes due to the anomalous functioning of the thyroid gland is called exophthalmos. It is also called proptosis, exorbitism, or exophthalmia. It can affect one or both the eyes of an individual. In this article, we will study the causes, diagnosis, and treatment of this disease.

What is Exophthalmos?

The exophthalmos definition depicts the bulging of the eyeball(s) due to the hyperactivity of the thyroid gland. It can also damage the optic nerves causing permanent blindness in some cases. This is why early diagnosis and treatment of this disease becomes mandatory. After diagnosis, proper treatment can lead to the eradication of this disease but the symptoms may take a few years to vanish. In fact, the ophthalmologists suggest going for corrective surgeries to make the eyeballs normal even after the disease is cured.

Many of the patients suffer from various kinds of vision issues. One of the common issues is double vision. Exophthalmos causes disorientation of the eyeballs resulting in a mismatch of the vision from both eyes. Whether it has affected one or both the eyes, it will still cause double vision due to improper orientation of the eyeballs in the sockets. It gets cured when the eyeballs resume their normal positions.

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The specialist doctors suggest medical consultation when symptoms appear for early diagnosis. Quick medical action is required to reverse the conditions of a patient’s eyeballs so that he does not lose his power of vision due to the deterioration of this condition.

Symptoms of Exophthalmos

As per the exophthalmos definition, the prime symptom will be bulging eyeballs outside the socket. It is a clear physical symptom of the deteriorated condition of this disease. How can a patient understand that his eyes are being affected by thyroid eye disease? Here is a list of symptoms to consider.

  • Pain in the eyeballs

  • Dry eyes

  • Irritation in the eyes

  • Sensitivity to any kind of light or photophobia

  • Shedding of tears or lacrimation

  • Continuous eye secretions

  • Double vision or diplopia due to extreme weakening of the muscles inside the eye sockets

  • Blurred vision

  • Partial or full blindness due to optic nerve compression

  • Eye movement difficulty due to improper muscular functioning

  • Feeling an irritating pressure behind the eyeballs

Apart from the symptoms in the eyes, it can also be connected with the other physiological symptoms of Grave’s disease. They are:

  • Irregular heartbeats

  • Increased blood pressure

  • Anxiety

  • Increased appetite

  • Diarrhea

  • Weight loss

  • Sleeping problems, etc.

All these symptoms are being analyzed before making a diagnosis. It is then a medical practitioner prescribes tests to confirm.

Causes of Exophthalmos

It is also called Grave’s ophthalmopathy disease that affects a lot of people due to the hyperactive thyroid glands. It is also considered an autoimmune disease where the tissues of one’s body are attacked by his own immune system. In this case, the immune system attacks the fatty soft tissues and muscles behind the eye sockets and causes inflammation.

The other Exophthalmos causes are:

  • Injury to the eyeballs

  • Hemorrhage behind the eyeballs

  • Anomalous shape of the blood vessels behind the eyeballs

  • Infection in the tissues of the eye sockets

  • Development of a tumour

How to Treat Exophthalmos?

Now that we know the reasons for hyperthyroidism exophthalmos, let us learn how doctors plan its treatment.

  • First, the diagnosis is done to identify the level and type of exophthalmos.

  • The test results help the doctors to understand the type of exophthalmos and the cause is identified first. For instance, pulsatile exophthalmos is a type of this disease where the symptoms of bulging eyes appear along with a visible pulsation of the affected eyeballs.

  • A treatment is then planned according to the cause and symptoms. In general, medications are prescribed to normalize the thyroid hormone levels in the bloodstream first. It is done to stop the disease from deteriorating.

  • The second treatment plan is to inject steroidal medicines intravenously to improve the inflammatory condition behind the eyeballs.

  • Once the eyeballs are reaching back to their normal positions after the control of the inflammation, corrective surgeries are done to align the eyeballs perfectly.

Apart from these invasive treatment procedures, eye drops are prescribed to reduce the irritation and dryness in the eyes. Doctors may also prescribe customized lenses to wear to neutralize the vision problems due to thyrotoxic exophthalmos.

If the problem is due to the development of a cancerous tumor then a patient might have to choose chemotherapy, radiotherapy, and corrective surgeries.

What are the Complications of Exophthalmos?

Now that we know the exophthalmos pathophysiology, let us check the complications it can cause.

  • Inflamed, red and painful protruding eyes

  • Gritty and dry eyes

  • Tearful eyes

  • Light sensitivity

  • Double vision may or may not appear

Proptosis vs Exophthalmos

Proptosis is the medical term defining the protrusion or displacement of any diseased organ or due to a disease developing somewhere else. On the other hand, proptosis of the eyeballs is termed exophthalmos.

This is a brief discussion of exophthalmos and its pathophysiology. The reasons for this disease can be reversed if a proper diagnosis is done. Initiating a treatment after learning the cause is mandatory for curing the disease.

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FAQs on Exophthalmos

1. What is autoimmune disease?

Ans: If we observe this medical term then we can understand that the immunity of an individual fails to recognize its own tissues and organs. It results in the attack of the immune system over the specific unrecognized tissues and organs causing various kinds of autoimmune diseases.

2. What is an exophthalmic goitre?

Ans: Grave’s disease, an autoimmune disease, is also called exophthalmic goitre. In this disease, a patient develops hyperthyroidism resulting in the protrusion of the eyeballs outside the sockets. One of the best methods to cure it is radio-iodine therapy. Iodine aids in curing goitre and help recede the symptoms of exophthalmos in a patient.

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