Proptosis - Causes, Symptoms, Diagnosis, Treatment, Pictures
What is Proptosis?
Proptosis is an eye condition characterized by an abnormal protrusion or bulging of one or both eyes.
Proptosis and exophthalmos are the two terms used to describe an abnormal bulging of the eyes and are used interchangeably. Proptosis on the other hand is an abnormal protrusion of the eye that is non-endocrine mediated while exophthalmos resulted from a thyroid or an endocrine mediated eye condition.
Some individuals may be seen with bulging eyes which is due to the normal variations in the anatomy of the eye. Proptosis is defined as a protrusion of the globe of the eye at a certain extent beyond the normal variation. The rapid onset of proptosis is deemed serious particularly if only one eye is affected and requires an immediate medical attention. Mild proptosis on the other hand can be managed properly and appropriately by an eye doctor.
Proptosis can affect both adult men and women without racial predilection although each gender and racial group varies in definition of proptosis based on the measurement of distance in globe protrusion. Children can also get affected by variation in measurements based on the age of the child. Bulging of one eye in a child is particularly a serious condition that requires a medical emergency.
Proptosis is a serious medical eye condition which can increase the intraocular pressure that is a potential risk for other eye diseases. The function of the eyelid to protect the eye adequately is compromised in proptosis which can result to eye problem such as epithelial death, ulceration and worst, corneal perforation. A decreased function in the optic nerve or an irreversible neuronal death is also potentially as a result of an interruption in the blood flow of the optic nerve. The forward protrusion of the eye can compromise the optic nerve when it is severely stretched beyond its limitations resulting in an adverse effect which can compromise the eyes and its functions.
The apparent prominence of the white of the eye between the upper eyelid and the colored part of the eye to a certain extent is indicative of a bulging eye. The inability of the eyelids to protect the eye that has protruded to an extent results in symptoms associated with the proptosis and the common symptoms include the following:
Bulging of the eyes to a particular extent is the most common complaint of patients where the white of the eye is prominent and cannot be protected by the lids.
Swelling of the eyelid is also associated with proptosis where the conjunctiva is red and bulging usually beneath the globe of the eye.
Pain is also common and is often the result of inflammation or an infection or may be due to a progressing tumor. A cornea that has been compromised due to the protrusion often results to pain also.
Impaired visual acuity may also occur especially if the optic nerve has been involved in the pathophysiology or if the macula is directly affected by the lesion which pushes on the back of the globe.
Double vision may also occur especially if the protrusion is due to a progressing tumor which restricts the extraocular muscle due to a compression caused by the growing tumor.
Dry eye is common due to the inability of the lids to protect the eyes which has bulged beyond the limitation of the eyelids.
The affected eye or eyes may have difficulty in movement due to the restrictions in the extraocular muscle. The eyes may also be seen with difficulty in fully closing during sleep or during blinking.
Other symptoms that may be associated with proptosis include the following:
- Onset of fever
- Headache in cases of tumor
- Thyroid symptoms may occur if bulging of the eyes is endocrine mediated.
Proptosis and exophthalmos both define the bulging condition or the abnormal forward protrusion of the eyes. They differ in the pathophysiology where the exophthalmos is mediated by a disease that involves the thyroid. Proptosis on the other hand is the result of other factors with the exception of thyroid disease.
Grave’s disease is the most common cause of eye bulging in the case of exophthalmos. It is an autoimmune disease involving the thyroid characterized by the overproduction of thyroid hormone of the thyroid gland.
Bulging of the eyes in proptosis is caused by various factors and diseases which can directly or indirectly affect the eyes. Proptosis can occur in one or both eyes depending on the cause while the onset can be rapid or progressive. The rapid onset is usually severe in extent and is more serious which may require an immediate medical attention. Injury, trauma and eye disorders that cause inflammation or infection in the eye can result to the protrusion.
The non-endocrine mediated and other causes of Proptosis include the following:
- Injury that causes bleeding behind the eye.
- Glaucoma or the fluid pressure causing damage to the optic nerve.
- Tumor whether malignant or not in the orbit of the eye can push the eyeball forward.
- Pseudotumor or the inflammatory and fibrous accumulation in the orbit can cause protrusion resulting to symptoms of pain and swelling.
- Infection of the surrounding tissue of the eye or also known as periorbital cellulitis.
- Vascular disorders affecting the circulatory system can also affect the eye and result to abnormal protrusion of the eye.
- Cancer of the white blood cells and cancer of the nerve tissue can both cause the abnormal protrusion of the eye.
Medical history taking is the initial step in diagnosing proptosis. The doctor will collect information pertinent to the onset of the condition. The medical history includes the previous incidence, medications, the initial onset and the period of time the eye has been protruding. Symptoms experienced or presented are also being noted to assess proptosis and the underlying condition that has led to the abnormal protrusion of the eye.
The physical examination will have the proptosis assessed under the well-lit room or utilizing the slit-lamp to evaluate the front structure of the eye. The orbit is also examined to note for swelling and other changes and to examine for tenderness and a mass or lump that may be growing. The optic nerve function is also being examined to check for visual acuity and any other impairment that may have involved the optic nerve leading to the protrusion of the eye.
Additional medical exams may also be requested to identify the underlying condition that resulted to the abnormal protrusion of the eye. Unilateral proptosis in children is a serious sign necessitating an immediate medical attention as the condition can prove to be fatal or may cause irreversible damage such as permanent blindness.
The treatment of proptosis depends on the underlying condition that contributed to the onset. The initial step in treating proptosis is identifying the underlying cause as an abnormal bulging of the eyes does not happen without any reason.
Relief of symptoms can be provided while treating the underlying condition or while identifying the underlying condition that resulted to abnormal protrusion. Artificial tears in the form of eye drop are usually given to relieve the symptom of dry eyes. Medications often help in the treatment of proptosis although this depends on the severity and the etiology of proptosis.
Proptosis resulting from an inflammation is usually treated with Corticosteroid to reduce the inflammation while proptosis resulting from an infection is usually given with anti-bacterial medication and any other medication depending on the pathogen that has infected.
Tumors causing the proptosis as managed with cancer treatment and therapy such as chemotherapy and radiation therapy. Damaged arteries and veins on the other hand that resulted to proptosis are surgically managed to repair the damages.
The goal of treatment in proptosis is to manage he abnormal protrusion while preventing further complications and other irreversible damage to the eyes that can impair the visual ability. The abnormal bulging of the eyes can affect the self-esteem of the affected individual and which can also affect the quality of life. Emotional support is also an important factor to achieve successful treatment and to assure patient that the condition can be managed.