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Eye diseases

Exophthalmos

Exoftalmos
It gives a "bulging eyes” look.
It may be a sign of hyperthyroidism
It is usually more common in women.

What is exophthalmos?

Exophthalmos is the term we use in ophthalmology to define eyes that protrude from their normal position, popularly known as “bulging eyes”. Exophthalmia is also called proptosis (hinting at the protrusion of the eyeball) and, although at first it may seem like a trivial pathology, the truth is that it can hide potentially serious diseases, such as hyperthyroidism or a tumour near the eye.

Contrary to exophthalmos, there is also enophthalmos, which looks like “sunken eyes”.

Exophthalmos does not give eye symptoms as such (although it can cause double vision). Since the shape and size of the eyes are not exactly the same for everyone, there are some aspects to consider when assessing it. It is generally not difficult to distinguish, because the eyeballs of people with exophthalmos stand out in a very conspicuous way. However, to be sure and differentiate non-pathological bulging eyes from an exophthalmos, we must look at the amount of sclera (white part of the eyeball) that we see when the patient’s eyes are open. If this is seen in the upper part of the eye, that is, between the upper eyelid and the iris, we are dealing with a case of exophthalmos.

Exophthalmos is a more common condition in women – although it can also affect men –, and different diseases and disorders can cause it. The most common pathology associated with this eye problem is hyperthyroidism, an endocrine disorder characterised by an overactive thyroid gland. This results in a thyroid orbitopathy that leads to proptosis of the eye.

Another common cause of exophthalmos is Graves’ disease, which also ends up causing hyperthyroidism. Likewise, certain eye infections and injuries, intraocular haemangiomas (abnormal growth of blood vessels), some tumours and diseases such as sarcoidosis (which causes swelling of the lymph nodes in the lungs, liver, eyes, skin …) can lead to the development of exophthalmos.

The solution of exophthalmos will depend on the underlying cause, since treating the underlying pathology (a tumour, hyperthyroidism, haemangioma …) will improve the eye alteration.

However, in many cases, and despite medical treatment, surgery may be necessary to enlarge the bony space containing the eyeball and adjacent tissues. In addition, we can also perform corrective surgery to prevent the shape of the eyes from being permanently altered or to improve the eyelids’ appearance and make them close properly. On the other hand, if the exophthalmos causes double vision, a surgery may be required to operate on the muscles responsible for the eyes’ correct alignment. At the Miranza clinics we specialise in each technique.