Exophthalmos

Exophthalmos (also called proptosis) is a condition where the eyes move forward. They look as if they are "popping out." This can happen in one or both eyes. When the eyes are pushed forward, damage can be done to:

  • The main nerve between the eye and the brain that contains the nerves for vision (optic nerve).

  • The muscles that make the eye move.

  • The inside of the eye from increased pressure (glaucoma).

  • The front surface of the eye (cornea) because of exposure and dryness.

CAUSES

  • Thyroid disease.

  • Overactive thyroid gland.

  • Certain diseases where the body reacts to its own tissues (autoimmune diseases).

  • Graves disease (a form of overactive thyroid disease).

  • Wegener's disease.

  • Others.

  • Anything pushing the eyes forward from behind.

  • Tumor(s).

  • Eye cancer.

  • Bleeding behind the eye from a tumor or blood vessel problems.

  • Trauma (with bleeding behind the eye).

  • Problems with the arteries and veins behind the eye (aneurysm, cavernous sinus thrombosis, etc).

  • Cysts or a pus filled area (abscess) behind the eye.

  • Tumors that have spread to the eye socket from cancer in other areas of the body (metastatic cancer).

  • Cancer of the blood system (lymphoma and others).

  • Infection behind the eye.

  • An abnormal skull structure.

  • Some genetic diseases and abnormalities.

  • Pseudoproptosis (or false proptosis). This is a condition where the eye looks like it is pushed forward but is really not. The eye is just bigger (longer) than normal, or the opposite eye is smaller than normal, which makes one eye look bigger.

  • Prominent eyes in otherwise normal people.

SYMPTOMS

  • Bulging eye(s).

  • Dry and irritated eyes.

  • Eyes not closing all the way when asleep.

  • Double vision – seeing two of everything (diplopia).

  • Trouble looking up with one or both eyes.

  • Symptoms of the disease causing exophthalmos. For instance, with an overactive thyroid gland, you may feel hot all of the time, sweat a lot, have weight loss and a lot of energy.

DIAGNOSIS

An eye professional can tell you if you have this condition during an eye exam. He or she can measure how far the eye(s) are forward compared to normal. X-rays, CT scan, ultrasound and other tests may be done to look at the area behind the eyes.

TREATMENT

  • Treatment is aimed at the condition causing exophthalmos.

  • If mild double vision is present, it may be possible to relieve the symptoms with special glasses containing prisms.

  • If severe double vision is present, or if there is danger to the eyes, surgery may be needed. Surgery can relieve the pressure on the eyes. It can also free up the eye muscles so the eyes can move properly.

SEEK MEDICAL CARE IF:

  • It looks like one or both eyes bulging forward.

  • You have double vision.

  • You have trouble looking up.

  • You generally do not feel well.