Causes of Exophthalmos
In adults, the most usual cause of exophthalmos is thyroid-related diseases such as Graves’ ophthalmopathy (Graves’ disease), an autoimmune disease that affects the thyroid gland. Similar to most autoimmune diseases, Graves’ disease is a result of the immune system attacking healthy tissues, which in turn leads to an overactive thyroid gland or hyperthyroidism. Research has shown that this condition affects 1 in 3 people with hyperthyroidism.
But in children, orbital cellulitis is often the main cause for unilateral exophthalmos and bilateral exophthalmos is likely to be a result of leukemia and neuroblastoma. However, in a child or adult, both unilateral and bilateral exophthalmos can be treated with exophthalmos/protruding eyes surgery.
A person with hyperthyroidism has a hyperactive thyroid gland that releases extra hormones and causes it to grow. The thyroid is located in the neck just below Adam’s apple. The hormones it produces, Thyroxine and Triiodothyronine, help to regulate the rate of metabolism, growth, and other essential functions of the body.
For a healthy person, the immune system should attack pathogens, substances, and organisms that are bad for us. Substances like bacteria, parasites, viruses and fungi, and cancer cells are often attacked by the immune system. However, in an unhealthy person when the immune system begins to attack healthy tissues, then this condition is known as an autoimmune reaction.
Graves’ disease is part of the autoimmune reactions and once a person’s immune system begins to attack the thyroid gland, this causes hyperthyroidism which often leads to Exophthalmos (bulging eyes)
As a result of hyperthyroidism, the muscles surrounding the eyes become swollen or inflamed, which leads to crowding in the bony orbit and gives way to the protrusion of the eyeballs.
However, hyperthyroidism does not immediately cause protruding eyes and it may take some time for it to happen.
People with the underactive thyroid gland (hypothyroidism) can also be occasionally affected by the exophthalmos and on rare occasions, people with normal thyroid function. Also, men and women who smoke are susceptible to exophthalmos (protruding eyes).
Exophthalmos can also have other causes as follows:
- Abnormally shaped vessels behind the eyes
- An injury to the eyes
- Bleeding behind the eyes
- An infection of the tissue behind the eye socket (orbital cellulitis)
- Cancerous tissues
- Accumulation of fluid in the tissues surrounding the eyeballs
- Vascular abnormalities of the orbit.
Symptoms of Exophthalmos
The major symptom of exophthalmos is the protrusion of the eyeballs, but symptoms such as pain and discomfort, cornmeal dryness, difficulty closing the eyes, scarring, and difficulty opening the eyes or blinking can also be experienced.
A person with exophthalmos (bulging eyes) can also experience the following:
- Eye irritation
- Sensitivity to light or photophobia
- Double vision caused by the weakening of the eye muscles
- Blindness if the optic nerve is compressed
- Blurred vision
- Eye secretions
- Unwanted shedding of tears
- Pressure behind and around the eyes
Diagnosis of Exophthalmos
Exophthalmos is mostly diagnosed through a physical assessment by an ophthalmologist but it can be easily recognizable by the protrusion of the eyes.
However, it is advised to undergo a series of tests when you notice your eyes are abnormally protruding. Some of the tests to undergo include:
- A blood test to find out if the thyroids glands are functioning as they should
- MRIs and CT scans to examine the eye socket or orbit as such scans can detect any form of abnormality in the eyes or around the eyes
- Measurement of the extent of the protrusion using equipment like an Exophthalmometer
- Imaging scans such as MRI and CTs to evaluate the structure of the brain.
Treatment Options of Exophthalmos
The treatment options for exophthalmos depend on the cause, the person’s age, and the state of the person’s health.
However, if it is caused by a thyroid problem, the treatment focuses on returning the thyroid hormones levels to normal. But, bringing the person’s thyroid hormone levels back to normal might not be the final solution. Other treatments like Exophthalmos (bulging eyes) surgery should be considered.
If the condition is caused by inflammation, corticosteroids may be prescribed.
In some cases of this condition, exophthalmos (protruding eyes) surgery is often considered the best option. Most times, surgery is advised if the patient’s eye veins and arteries are disconnected.
Other non-surgical treatments for the Exophthalmos (bulging eyes) are:
- Sunglasses for eyes sensitivity
- Natural tears for eye lubrication
- Medications that decrease the immune response such as cyclosporine
- Corticosteroids for inflammation
- Medications that are capable of blocking antibodies such as Rituximab
If the exophthalmos (bulging eyes) has advanced to a severe stage where the only option is the exophthalmos (bulging eyes) surgery, one can consider the following surgical options
Eyelid Surgery: this surgical procedure is carried out to protect the cornea and prevent the outer eyeball from damage
Orbital decompression: This is a procedure in which the ophthalmologist enlarges the orbit to create room for the eye muscles and tissues
Eye muscle surgery: This surgical procedure is done to correct abnormal eye surgery.
Complications of Exophthalmos
When a person with the condition refuses to get it treated or undergo exophthalmos surgery, certain complications may arise.
If exophthalmos is left untreated, the person will be unable to close the eyelids during sleep, which would lead to cornea drying and retina damage. And when the corneas are left dried for a long period, there is a high risk of infections which often leads to damaged vision.
Persons with exophthalmos (bulging eyes) disease are very likely to experience conjunctivitis or superior limbic keratoconjunctivitis in which the area above the cornea inflames as a result of continuous and abnormal blinking.
Furthermore, in some very rare cases, some people might experience compression of the ophthalmic artery or compression of the optic nerve which affects their eyesight and eventually leads to blindness.
Exophthalmos is not quite a severe condition. Fortunately, the condition can be treated with various forms of treatment. However, the longer a person remains with untreated exophthalmos, the worse the severity of the condition becomes and the more it begins to defy all treatment methods.
Thus, it is crucial to seek medical intervention immediately after a condition like exophthalmos is diagnosed so treatment can commence instantly.
Exophthalmos surgery cost in Iran
The cost of protruding eye (exophthalmos) surgery in Iran is highly lower than that in most other countries and this is because of economic factors. However, it is difficult to give a precise price quote for bulging eye surgery in Iran unless we know more about your condition and the severity of the problem. You can send us a message on WhatsApp or fill out our consultation form for a free consultation and more information about exophthalmos eye treatment in Iran.