From the Guidelines
Proptosis refers to the abnormal forward displacement or bulging of the eyeball from its normal position in the eye socket (orbit), which can be caused by various factors including thyroid eye disease, orbital inflammation, tumors, infections, or trauma, as noted in studies such as 1. This condition occurs when there is increased pressure behind the eye, pushing it outward. Common symptoms of proptosis include eye pain, double vision, decreased vision, difficulty closing the eyelid completely, or a sensation of pressure. The degree of proptosis can be measured using an exophthalmometer, which helps quantify the forward displacement, as discussed in 1 and 1. Some key points to consider in the management of proptosis include:
- Treatment depends on the underlying cause and may include medications like corticosteroids for inflammation, antibiotics for infections, or surgery for tumors or severe cases, as mentioned in 1.
- Proptosis requires prompt medical evaluation as it can potentially lead to serious complications including corneal damage from exposure or compression of the optic nerve resulting in vision loss, highlighted in 1 and 1.
- The use of teprotumumab, a human monoclonal antibody inhibitor of IGF-IR, has been shown to reduce proptosis and the clinical activity score of disease in many patients with active thyroid eye disease, as reported in 1.
- Orbital decompression, high-dose steroids, or radiation treatment should be considered for severe proptosis or optic neuropathy, as indicated in 1 and 1.
- Patients with concurrent proptosis and significant strabismus may require consultation with an orbital specialist to consider orbital decompression surgery prior to strabismus surgery, as suggested in 1 and 1. Overall, the management of proptosis should prioritize reducing the risk of complications and improving the patient's quality of life, as emphasized in 1 and 1.
From the Research
Definition of Proptosis
Proptosis refers to a condition where the eyeball protrudes or bulges out of the orbit, which can be caused by various factors, including thyroid eye disease.
Causes of Proptosis
- Thyroid eye disease (TED) is the most common cause of proptosis in adults, as stated in studies 2, 3, 4, 5, 6.
- Other possible causes of proptosis include orbital tumors, as mentioned in study 3.
Characteristics of Proptosis
- Proptosis can lead to significant visual alterations and is potentially sight-threatening, as noted in study 4.
- It can also cause dry eyes, strabismus, and optic neuropathy, as mentioned in study 6.
Treatment of Proptosis
- Teprotumumab, an insulin-like growth factor-1 receptor antagonist antibody, has been shown to be effective in reducing proptosis in patients with thyroid eye disease, as reported in studies 4, 5.
- Orbital decompression surgery is also a treatment option for proptosis, and has been compared to teprotumumab in study 5.
- The choice of treatment for proptosis depends on the underlying cause and severity of the condition, as well as the patient's overall health and medical history.