From the Guidelines
Exophthalmos is primarily caused by inflammation and swelling of the tissues behind and around the eye, pushing the eyeball forward, with the most common cause being Graves' disease, an autoimmune condition where antibodies attack the thyroid gland and orbital tissues, as noted in the most recent study 1.
Causes of Exophthalmos
The causes of exophthalmos can be categorized into several groups, including:
- Autoimmune disorders, such as Graves' disease, which is the most common cause, as mentioned in 1
- Orbital tumors, infections, vascular malformations, and trauma that create space-occupying lesions behind the eye, as discussed in 1
- Other conditions, such as thyroid eye disease, IgG4-related disease, and idiopathic orbital inflammatory syndrome, which can also present with unilateral or bilateral proptosis, as noted in 1
Diagnosis and Treatment
Diagnosis of exophthalmos typically involves a thorough clinical examination, including measurement of the exophthalmos by exophthalmometer, as mentioned in 1, and imaging studies such as MRI or CT scans, as discussed in 1. Treatment depends on the underlying cause, but may include managing thyroid dysfunction with medications like methimazole or propylthiouracil, corticosteroids to reduce inflammation, orbital radiation therapy, or surgery in severe cases, as noted in 1 and 1. Patients with exophthalmos should seek prompt medical attention to prevent serious complications, including corneal damage, double vision, and even vision loss if pressure on the optic nerve becomes severe, as emphasized in 1.
From the Research
Causes of Exophthalmos
- Exophthalmos, or protrusion of the eyeball, is a condition that can be caused by various factors, including:
- Infiltration of orbital fat, extraocular muscles, and the lacrimal gland, leading to compression of the intraorbital contents 2
- Expansion of the orbital contents around the eye by excessive fat generation (adipogenesis) and overproduction of extracellular matrix components, especially hyaluronan (HA) from preadipocytes/fibroblasts (PFs) 3
- Graves' orbitopathy (GO) is a common cause of exophthalmos, characterized by inflammatory autoimmune conditions that lead to the expansion of orbital contents 4, 3
- Other conditions, such as dysthyroid orbitopathy, can also cause exophthalmos, and orbital bony decompression may be necessary to manage severe manifestations 5
Pathological Features of Exophthalmos
- The pathological features of exophthalmos include:
- Adipogenesis and overproduction of extracellular matrix components, especially hyaluronan (HA) 3
- Infiltration of orbital fat, extraocular muscles, and the lacrimal gland 2
- Compression of the intraorbital contents, leading to disorders of the lid-corneal interface, keratopathy, motility disturbances, and optic neuropathy 2
Treatment and Management of Exophthalmos
- Orbital decompression is a consolidated procedure for the treatment of exophthalmos in Graves' orbitopathy (GO) 4
- Various surgical techniques, including fat decompression, lateral wall decompression, and medial wall decompression, can be used to manage exophthalmos 2, 4, 5
- Non-surgical treatments, such as steroid-sparing therapies and novel modalities for objectively monitoring disease activity, are also being developed 6