Exophthalmos, also called proptosis, is abnormal forward protrusion of one or both eyeballs beyond the bony orbit. It can arise from orbital inflammation, mass lesions, vascular abnormalities, or expansion of tissues behind the eye.
Causes and Features
The most common cause in adults is thyroid eye disease, in which autoimmune inflammation enlarges the extraocular muscles and orbital fat. Exophthalmos can also result from tumours, infections, or vascular malformations within the orbit.
- May be unilateral or bilateral depending on the underlying cause
- Associated symptoms include lid retraction, redness, or swelling
- Exposure of the ocular surface can lead to dryness or corneal damage
- Double vision or optic nerve compression may occur in more advanced cases
Assessment and Management
Investigation includes detailed eye examination, measurement of proptosis, and imaging of the orbits to identify structural changes. Management addresses both the underlying systemic condition and local eye complications, with treatments ranging from lubricants to medical therapy, radiotherapy, or surgery.
- Endocrine assessment is important when thyroid eye disease is suspected
- Urgent review is needed if vision or colour perception deteriorates
- Protecting the cornea with lubrication and lid taping may be necessary
- Regular monitoring tracks disease activity and guides timing of interventions
