Protruding eyeballs (exophthalmia) represent a protrusion of the eyeballs (exophthalmos) from the eye socket that can occur on one or both sides. In common parlance, protruding eyes are often disparagingly referred to as googly eyes.
What are protruding eyeballs?
Protruding eyeballs (exophthalmia) represent a protrusion of the eyeballs (exophthalmos) from the orbit, which may be unilateral or bilateral. Eyeballs protruding from the orbit (exophthalmia) can be divided into degrees of severity depending on the severity of the exophthalmia:
In grade I, the eyelid begins to retract with only limited movement of the eye. Swollen conjunctiva and eyelids as well as increased sensitivity to light become noticeable in grade II. From grade III on, the eyeballs are conspicuously bulging. Grade IV is characterized by blurred vision or the recognition of double images. If grade V is reached, the eyeballs dry out and the cornea becomes cloudy and its surface is destroyed. In grade VI, there is impairment of the optic nerves, so that vision may be reduced to blindness. However, protruding eyeballs do not represent an independent disease, but only a symptom that can be triggered by a wide variety of diseases.
Causes
Protruding eyes can occur, among other things, in certain autoimmune diseases that are triggered by a dysfunction of the immune system. These autoimmune diseases include basedow’s disease and Hashimoto’s thyroiditis, in which hyperthyroidism leads to increased hormone secretion that can cause inflammation of the eye, triggering exophthalmia. Purulent inflammation of the eyeball (orbital phlegmon) also causes the eyeball tissue to swell and may push the eyeball forward. Benign or malignant tumors may develop in the orbit, which can lead to exophthalmia. Benign tumors include hemangioma (blood sponge) and neurinoma (schwannoma), which originates from cells that coat nerve fibers. Malignant tumors are retinoblastoma, which is a retinal tumor, and neuroblastoma, which affects nerve tissue. The so-called exophthalmus intermittens occurs due to varicose veins in the eye socket, in which blood congestion occurs during certain head postures. However, protruding eyeballs can also be caused by injuries to blood vessels in the orbit, thrombosis-related blood stasis in the eye, and malformations of the brain (with its meninges or even parts of the brain entering the orbit).
Diseases with this symptom
- Retinoblastoma
- Histiocytosis X
- Graves’ disease
- Exophthalmos
- Hemangioma
- Hashimoto’s thyroiditis
- Hyperthyroidism
- Neurinoma
- Orbitaphlegmone
Diagnosis and course
Protruding eyes are first assessed by the examining physician by looking from above and behind to determine the degree of severity in which one eyeball or both eyeballs are affected by the disease. In addition, the protrusion of the eyes can also be precisely measured by means of a so-called exophthalmometer. In order to determine possible tumors and inflammations as well as their development over time, magnetic resonance imaging as well as computed tomography are used, with the help of which precise images of the eyeball can be created. Sonography (ultrasound examination) and X-ray may also be helpful in diagnosis. If hyperthyroidism is a possible cause of exophthalmia, a blood test is performed to determine thyroid levels and detect signs of any inflammation. Protruding eyeballs also necessitate measurement of eye pressure and determination of visual field.
Complications
Protruding eyeballs are associated with psychological problems in a large number of cases. Teasing, bullying, or dismissive behavior of other people can be experienced as very painful and distressing. Self-esteem drops and social withdrawal follows. In severe cases, melancholy or depression develops. Since, depending on the degree of severity, various impairments of vision are present, there may be problems in coping with everyday life.Under certain circumstances, the affected person is dependent on the help of other people. This is especially true when blindness sets in. If hormonal causes are the reason for the protruding eyeballs, hormone preparations are administered. These interfere with the hormonal system and can have corresponding side effects. They affect the libido and can change the monthly cycle of the woman. If the presence of a tumor is diagnosed, surgery is performed and often chemotherapy is administered. Both are associated with corresponding risks and side effects. After surgery, there is a possibility of sequelae such as deterioration of vision. If left untreated, protruding eyeballs run the risk of drying out the eye. This increases the risk of permanent damage to the cornea. Eyelid closure is more difficult or is no longer fully accomplished.
When should you go to the doctor?
Protruding eyeballs should never be mistaken for just a blemish. It is a symptom that can be attributed to various underlying diseases. Therefore, protruding eyeballs are an urgent reason to see a doctor, preferably the family doctor first. After initial preparatory examinations, the physician decides on further treatment, including referral to the appropriate specialist. Although protruding eyeballs are a symptom, they may well be due to an eye disease, which is followed by a visit to the ophthalmologist. Another common cause of bulging eyes is autoimmune diseases, including hyperthyroidism. In such a case, an endocrinologist is the right specialist. Consultation with an internist or neurologist can also provide helpful insights into the development of protruding eyeballs. In any case, the cause should be investigated. On the one hand, the triggering disease must be treated, and on the other hand, the permanently protruding eyeballs themselves can cause damage that must be prevented. Depending on the severity of the protrusion of the eyeballs, pronounced protrusion may even lead to blindness.
Treatment and therapy
Protruding eyeballs are treated according to the underlying disease identified. A primary goal is to exclude complications of the disease as much as possible. Because progressive exophthalmia carries the risk of corneal desiccation and destruction, regular artificial moistening of the cornea is of particular importance in addition to careful eye care. In individual cases, the upper and lower eyelids are partially sutured together (tarsorrhaphy) to restore eyelid closure. Antibiotics are used if the protrusion of the eye is due to abscesses or phlegmon (inflammatory eye infection). These sites of inflammation may need to be previously opened during a surgical procedure to allow the purulent contents to drain. Benign and malignant tumors may need to be surgically removed. If a basedow’s disease is present, the overproduction of thyroid hormones must be reduced. For this purpose, so-called thyreostatics can be administered, which have an antithyroid effect. Protruding eyeballs may also indicate radioiodine therapy, which involves the targeted destruction of thyroid tissue to reduce hormone secretion.
Outlook and prognosis
Treatment of protruding eyeballs (exophthalmos) depends on the causative disease. Therapy often requires the involvement of different specialists. Ear, nose, and throat physicians, internists, neurologists, facial surgeons, and psychologists are usually called in. If the protruding eyeballs result from a metabolic disorder due to a malfunction of the thyroid gland, this is first treated with medication. Even if the thyroid gland is properly adjusted again, it must be constantly monitored so that changes can be detected before the exophthalmos worsens further. The position of the eyeballs does not regress in about 70 percent of patients even after successful treatment of the thyroid gland. It is therefore important to take measures to prevent further damage to the eye. It is particularly important to prevent the eye from drying out and to keep the cornea constantly moist. This is the only way to prevent inflammation, ulcers, tears or other injuries.In this way, the mobility of the eye is also improved. However, the patient must come to terms with the permanent misalignment of the eyeballs. Patients who develop mental suffering or complexes from this can be helped by psychotherapy.
Prevention
To prevent protruding eyeballs or at least worsening of symptoms, the particular disease underlying exophthalmia must be addressed. Eye hygiene and eye care can at least partially prevent ocular inflammation. If protruding eyeballs (exophthalmia) are already detectable, early diagnosis and treatment must prevent worsening of the disease to avoid imminent irreversible damage, including loss of eyesight.
What you can do yourself
Since protruding eyeballs can have different causes, the method of relief also depends on them. In general, it should be noted that going to the doctor should be done immediately. However, some self-help measures can be taken to relieve the discomfort caused by the symptom. Eye drops can be used as the simplest remedy. These are easy to use and cause side effects in very few people. Mainly, eye drops ensure that the cornea is moistened and a possible drying of the eye is absent. Sunglasses offer further help. These not only offer protection from dangerous UV radiation, but also give sufferers a little more security, since the bulging eyes are not immediately noticeable. Inflammations often accompany this disease, which can be treated well with cortisone. If veins and arteries are damaged, surgery must be performed to restore them. If the cause of protruding eyeballs is thyroid disease, beta blockers or thyrostatic drugs can be taken. If these medications do not improve the situation, it may be decided to remove all or part of the thyroid gland. However, this entails hormone therapy for the patient, since the natural control of hormones no longer functions. Furthermore, a stable circle of family or friends is a great help. People with this disease can suffer from low self-esteem. Therefore, a stable environment provides security and emotional help. Care from a psychologist or psychotherapist can also help in dealing with this symptom.