Exophthalmos: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate exophthalmos (protrusion of the eyes; googly eyes):

Leading symptom

  • Protrusion of the bulb of the eye from the eye socket (orbit) with simultaneous widening of the palpebral fissure.

The following are symptoms and complaints of endocrine orbitopathy (EO) as the most common cause of exophthalmos:

  • Exophthalmos (synonyms: endocrine ophthalmopathy; ophthalmoptosis; ophthalmopathy; protrusio bulbi; popularly known as “googly eyes”) – pathologic protrusion of the eyeball from the orbit (orbita) [Occurrence: before, during, or after the onset of hyperthyroidism]Occurrence of exophthalmos’ usually bilateral, often asymmetric, but almost never unilateral.
  • Redness of the conjunctiva (conjunctiva).
  • Incomplete closure of the eyelids (lagophthalmos).
  • Foreign body sensation in the eyes and increased lacrimation
  • When lowering the gaze, the upper eyelid remains behind, so that in exophthalmos the part of the sclera visible above the cornea is enlarged (Graefe’s sign)
  • Corneal lesions (corneal injuries).
  • If necessary, eye muscle involvement and eye muscle paresis with double vision.
  • When the optic nerve is compressed, there is a decrease in visual acuity (visual acuity) and limitation of color vision

The above symptoms or complaints occur in 40-60% of cases in Graves’ disease (form of hyperthyroidism (hyperthyroidism) caused by an autoimmune disease (= immune hyperthyroidism)). For more on Graves’ disease, see the disease of the same name.