What is Exophthalmos?

Orbital inflammation, edema, tumors or trauma, cavernous sinus thrombosis, or enlarged eyeballs (such as congenital glaucoma and unilateral high myopia) can cause one or both eyes to protrude.

Basic Information

nickname

Proptosis

English name

exophthalmos

Visiting department

Ophthalmology, Endocrinology

Common causes

Orbital inflammation, edema, tumor or trauma, cavernous sinus thrombosis or enlarged eyeballs

Common symptoms

Unilateral or bilateral eyeball protrusion beyond normal standards

Causes of Exophthalmos

Orbital tissue edema and lymphatic infiltration can cause unilateral or bilateral exophthalmos when thyroid function is abnormal. Sudden unilateral exophthalmos are usually caused by orbital or paranasal sinus bleeding or inflammation. Those who took 2 to 3 weeks were caused by chronic inflammation or orbital pseudotumor (non-neoplastic cell infiltration and proliferation), while those with chronic onset were mostly caused by tumors.

Arteriovenous tumors of the internal carotid artery and cavernous sinus can cause pulsating eyeballs with noise. It may be caused by carotid-cavernous sinus fistula after trauma, which can be confirmed by angiography. Trauma or infection (especially the face) can cause cavernous sinus thrombosis with unilateral eyeball protrusion and fever. Unilateral high myopia or meningioma can cause unilateral exophthalmos.

Eyeball clinical manifestations

The degree of eyeball protrusion can be measured with eyeball meter. If the eyeball protrusion continues to develop, the eyeball exposure can lead to corneal dryness, infection and ulcer formation.

Endocrine exophthalmos

Endocrine exophthalmos is also known as Basedow disease or Graves disease or exophthalmic goiter. Exophthalmos is one of its main symptoms. The etiology of this disease is not completely clear at present, and it is generally believed that it is closely related to pituitary-thyroid dysfunction. Clinically, the disease can be divided into thyroid toxicity caused by hyperthyroidism.

2. Pulsating eyeball

Pulsating eyeballs are common in the internal carotid artery and cavernous sinus fistula. The internal carotid artery passes through the cavernous sinus and is a common site for arteriovenous fistula. The causes of this disease can be divided into two categories:

(1) Injury is seen in skull base fractures or penetrating injuries.

(2) Idiopathic disease is rare and occurs in patients with congenital or acquired internal carotid aneurysms or arteriosclerosis, which are mostly unilateral.

3. Intermittent eyeballs

Intermittent eyeballs are mostly unilateral, with a higher incidence in the left eye than in the right eye, which is more common in male patients. Exophthalmos are mostly caused by congenital or acquired intraorbital veins, especially supraorbital varices. No trauma and other medical history.

Exophthalmos

For unexplained unilateral eyeball protrusion, a thyroid function test should be performed. If the thyroid function is normal or the eyeball protrusion is sudden, an orbital CT scan or MRI should be performed to find the intraorbital cause. The degree of eyeball protrusion can be measured with an eyeball meter.

Exophthalmos diagnosis

1. temporary eyeball

It is an important feature of this disease, and its prominence can be increased or decreased with the change of head position, the duration is different, and the attack is often or occasional. When the patient lowers his head, exhales strongly, compresses the jugular vein, or twists the jugular side, he can cause temporary eyeball protrusion, and also shows: drooping of the upper eyelid, eyelid swelling, conjunctival congestion and edema, dilated pupils, and retinal varices , Blurred nipple realm, eye movement disorders and increased intraocular pressure.

2. During an attack

There is tension in the eye, occasional diplopia and temporary vision loss, and systemic symptoms such as dizziness, headache, nausea, vomiting, and tinnitus, or dilated temporal and facial veins.

3. After the attack

The eyeball returned to the original position, all the above symptoms subsided, but often showed invagination of the eyeball, which was due to vasodilation and atrophy caused by long-term compression of the orbital fat tissue.

Eye protrusion treatment

Treatment depends on the cause, and surgical treatment is mainly used. The common carotid artery should be ligated for arteriovenous tumors. Eye protrusion caused by hyperthyroidism may subside after the control of hyperthyroidism. Occasionally, stubborn cases require orbital decompression surgery.

The exposed cornea must be protected when the eyeballs protrude. Exudative keratitis is often caused by bulging eyeballs caused by the thyroid. Systemic application of corticosteroids often helps to control edema and pseudotumors (such as oral prednisone, which is gradually reduced to the smallest dose that can control eye protrusion). The tumor must be removed.