Exophthalmos

The exophthalmos (synonyms: exophthalmos, Ophthalmoptose, Ophtalmopathie, popularly known as " bug-eyed ") is the pathological protrusion of the eyeball from the eye socket (orbit ).

  • 3.1 Clinical examination
  • 3.2 Exophthalmometer
  • 3.3 imaging
  • 3.4 Laboratory tests
  • 3.5 auscultation
  • 3.6 Severity Classification

Symptoms

  • Protrusion of the eyeball one or both sides
  • In some cases pain
  • Diplopia due to the influence of the eye muscles and the orbital nerves ( called exophthalmische ophthalmoplegia of the oculomotor nerve )
  • Drying of the cornea ( xerophthalmia )
  • Possibly ulceration and inflammation of the cornea

Cause

Endocrine exophthalmos

(Syn. endocrine ophthalmopathy )

In Graves' disease, in which disease Ord-Thyreoiditis/Hashimoto-Thyreoiditis it can accompany autoimmune inflammation in the area of the orbit, especially in the orbital fat, arrive. This inflammation leads to the swelling of the retrobulbar tissue and proliferation. The exophthalmos is on both sides in the majority of cases.

Exophthalmos pulsans

A pulsating exophthalmos can be found in most traumatic arteriovenous short circuits between orbital and orbital veins arteries or the cavernous sinus.

Orbital cellulitis

When orbital cellulitis, the tissue of the orbit is inflamed diffuse. Inflammation occurs Due to the swelling of the orbital tissues and displacement of the eyeball forward.

Exophthalmos with orbital tumors

In the area of the eye socket benign and malignant tumors occur (eg, benign: hemangioma, schwannoma, viciously, neuroblastoma, retinoblastoma, and others). By tumor growth occurs to displacement of the eyeball to the front. Also metastases or involvement of the eye socket, usually with malignant systemic diseases (eg, lymphoma, leukemia, histiocytosis X ) occur. The exophthalmos is usually unilateral.

Exophthalmos intermittens

It is a dependent of the head posture exophthalmos congenital or acquired varicose veins in the orbit. Depending on the position of the head it comes to stasis in the varicose vessel with a protrusion of the eyeball.

Exophthalmos in Retrobulbärhämatom

If after a blunt trauma to the back not a subconjunctival hemorrhage limited to, a Retrobulbärhämatom can form, ie a bruise behind the eyeball. This can also lead to exophthalmos.

Diagnostics

Clinical examination

It considers both eyeballs from behind the top of the seated patient and can thus assess the extent and notice a difference between the sides.

Exophthalmometer

The exophthalmos and its progression / regression can be measured using a Exophthalmometers.

Imaging

With the help of CT and MRI, the structures of the orbit can be represented. This tumors or inflammation can be diagnosed. Also, the ultrasound is used for the diagnosis of the orbit.

Laboratory tests

  • Endocrine exophthalmos: Studies of thyroid function (thyroxine, triiodothyronine, TRH, TSH, autoantibodies)
  • In cases of suspected orbital cellulitis: study of inflammatory markers (CRP, leukocytes, and others)

Auscultation

In arteriovenous short circuits can auscultate a pulse - synchronous sound.

Severity classification

  • Grade I: Retraction of the upper eyelid ( Dalrymple phenomenon), convergence weakness ( Moebius characters).
  • Grade II: involvement of the ( externally assessable ) connective tissue: the eyelids, chemosis, epiphora, photophobia
  • Grade III: protrusion of the eyeball with and without the eyelids ( quantified by use of a Exophthalmometers )
  • Grade V ( with corneal involvement ): mostly desiccating eyeball ( lagophthalmos ) with turbidity and surface destruction ( ulceration ) of the cornea ( cornea)
  • Grade VI ( involvement of the optic nerve optic nerve ): Sehausfälle to vision loss

Therapy

The treatment of exophthalmos depends on the causal underlying disease. Phlegmon or abscess may need to be relieved and treated with antibiotics. Tumors or retrobulbar fat can be treated surgically.

Complications

  • Malignant exophthalmos: When malignant exophthalmos it comes to a painful and progressive emergence of the eyeball with unsatisfactory eyelid closure ( lagophthalmos ) and drying of the cornea ( xerophthalmia ).
  • Corneal ulceration
  • Conjunctivitis
  • Intraocular pressure ( see Glaucoma )
Extraocular muscles C-reactive protein Antibiosis
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