If you have bulging eyes, you might just think of the condition as an aesthetic problem. However, bulging eyes, which is called exophthalmos, can cause problems with the way you actually see the world, too.
As an orbital decompression specialist, Raymond Douglas, MD, PhD, can examine you to diagnose your exophthalmos at our office in Beverly Hills, California. In order to avoid future complications related to exophthalmos, you may need orbital decompression treatment.
Here’s what Dr. Douglas wants his patients to know about the vision risks associated with exophthalmos, and how expert treatment can protect your eyes from harmful pressure.
What is Exophthalmos?
Exophthalmos is a medical term that means the eyeballs are bulging out of their sockets. It’s most noticeable in the eyes, where they look like they’re being pushed forward. This is caused by an increase in the volume of tissue behind the eyeball, such as inflammation, swelling or fat accumulation.
In medical terms, exophthalmos is often used interchangeably with proptosis, but proptosis can mean any protrusion of the eye, whether or not it’s caused by a disease. Exophthalmos specifically means both eyes are protruding and is often associated with thyroid eye disease (TED), but other causes exist.
It’s most commonly associated with thyroid disorders but can also be caused by tumors, trauma or vascular issues. Because exophthalmos can affect vision and lead to dryness, infection and even blindness, early diagnosis and treatment are key to preserving eye health.
Why Do Your Eyes Bulge?
Thyroid conditions, notably Graves’ disease, can leave your eye muscles and the fatty tissue inside your eye sockets inflamed. If you develop exophthalmos, the inflammation results in insufficient space in your eye sockets for your eyeballs. Your eyes can start to appear like they’re protruding or bulging out of their sockets.
Causes of Exophthalmos
Exophthalmos can be caused by many things. The most common cause is thyroid eye disease (TED), especially in patients with Graves’ disease, a thyroid condition that causes inflammation around the eyes. But there are other causes:
- Tumors: Tumors in the orbit (eye socket) can push on the eye and make it bulge out. Benign and malignant tumors can cause exophthalmos.
- Inflammation: Inflammatory conditions such as orbital cellulitis, an infection of the tissues around the eye, can cause swelling and protrusion of the eyeballs.
- Vascular Causes: Carotid-cavernous fistulas, abnormal connections between the carotid artery and the cavernous sinus, can cause increased pressure in the orbit and exophthalmos.
- Trauma: Physical injury or fractures around the orbit can cause swelling and displace the eyeball.
How Exophthalmos is Diagnosed
Diagnosing exophthalmos involves a thorough evaluation of your symptoms and medical history. Here’s how it’s done:
Clinical Signs:
- Proptosis Measurement: A doctor will measure the degree of eye protrusion to assess the severity of exophthalmos.
- Eye Movement Tests: These tests check for restricted eye movements which can indicate orbital inflammation or other eye conditions.
Imaging:
- CT (Computed Tomography): A CT scan of the orbit shows detailed images of the eye socket to detect any abnormalities such as inflammation, tumors or vascular issues.
- MRI (Magnetic Resonance Imaging): MRI provides more detailed soft tissue imaging and is useful in evaluating the extent of inflammation or other pathologies in the eye area.
- Ultrasound: In some cases, an ultrasound can be used to assess the extent of swelling or inflammation.
Blood Tests:
- Thyroid Panels: Blood tests to check thyroid hormone levels help identify thyroid-related causes of exophthalmos, especially in patients with suspected Graves’ disease.
- Inflammation Markers: Blood tests to check for elevated inflammation markers (e.g. C-reactive protein, sedimentation rate) may suggest an underlying inflammatory cause of exophthalmos.
Recognizing the Symptoms
Exophthalmos can cause a variety of symptoms, which may vary depending on the underlying cause and the severity of the condition.
Here are some common symptoms:
- Grittiness: A sensation of something being in the eye, often caused by the inability to fully close the eyelids.
- Light Sensitivity: Increased sensitivity to bright lights or glare is common, as the eyes are more exposed to the environment.
- Diplopia (Double Vision): Patients may experience double vision, especially when trying to look in different directions.
- Vision Distortion: Some individuals notice that their vision becomes distorted due to the abnormal position of the eye or pressure within the eye socket.
- Eyeball Displacement or Deformity: In more severe cases, the eyeballs may be visibly displaced, or the shape of the eyes may change due to pressure and swelling.
- Psychological Effects: The cosmetic appearance of exophthalmos can affect self-esteem and lead to anxiety or depression, as individuals may feel self-conscious about their appearance.
Potentially Serious Complications from Exophthalmos
If you have exophthalmos, you can face potentially serious complications that may even threaten your vision. You might not be able to close your eyes properly, even at night, allowing your corneas to become dry and damaged, increasing your risk for potentially vision-damaging ulcers and infections.
People with exophthalmos may notice that their eyes feel irritated, or experience a sensation of grittiness or dryness in the eyes. Patients suffering from exophthalmos are also at higher risk of developing a specific type of conjunctivitis, which is a form of eye inflammation commonly known as pink eye.
As you suffer from increased orbital pressure due to exophthalmos, you can start to experience double vision or eyeball deformity. It’s rare, but compression of your optic nerve or ophthalmic artery can ultimately threaten your eyesight.
Complications of Untreated Exophthalmos
Untreated exophthalmos can cause severe complications that affect the eyes and overall life:
- Vision Loss or Optic Neuropathy: Prolonged pressure on the optic nerve can cause optic neuropathy, which can lead to permanent vision loss if not treated.
- Eyelid Retraction and Lagophthalmos: In some cases, the eyelids can retract making it difficult to close the eyes completely. This can lead to dry eyes and more complications.
- Orbital Pain or Pressure: Increased pressure in the eye socket can cause a lot of discomfort or pain, and in some cases, the pressure can become unbearable.
- Emotional and Psychosocial Impact: The cosmetic changes of exophthalmos can cause emotional distress and affect social interactions and overall mental health.
Exophthalmos Treatments To Protect Your Vision
Dr. Douglas offers world-class oculoplastic and reconstructive surgery services, and specializes in orbital decompression treatment. He can determine the underlying cause for your bulging eyes, and do what’s needed to protect your eyes from harmful pressure.
If you’re diagnosed with exophthalmos, Dr. Douglas recommends that you immediately quit smoking and develop a treatment plan for any potential thyroid problems. Depending on your situation, you may also need surgical treatment to reduce pressure around your eyes.
If you require orbital decompression surgery, Dr. Douglas removes fat and bone from your eye socket, giving your eyeballs the space they need. To prepare for the procedure, he uses CT scan imaging to target the exact area(s) of your eye for surgical treatment.
To learn more about how orbital decompression could protect your vision and resolve your eye protrusion, get in touch with our office. You can schedule your consultation over the phone or send us a message online today.
