Understanding Proptosis: Symptoms, Causes, and Treatment Options

What is Proptosis?

Proptosis refers to the displacement of one or both eyeballs, with a notable protrusion typically measured at over 2 millimeters. It’s often synonymous with the term exophthalmos, derived from Greek words meaning "bulging eyes." A related condition, buphthalmos, describes an enlarged eye, typically present at birth and often resulting from congenital glaucoma.

What Causes Bulging Eyes?

Proptosis can result from several underlying factors, though hormonal imbalances remain the most prevalent. Below are some of the main causes:

1. Thyroid Eye Disease (TED)

TED is an autoimmune disorder and the leading cause of proptosis. Approximately one-third of individuals with unilateral proptosis are found to have elevated thyroid hormone levels, often linked to hyperthyroidism. An estimated 90% of bilateral proptosis cases involve abnormal hormone levels. Many with TED also suffer from Graves’ disease, which may occur in about 25% of individuals diagnosed.

If left untreated, TED can compress the optic nerve, potentially leading to permanent vision loss. Additionally, more than 90% of those with TED experience eyelid retraction, which can exacerbate dry eye issues.

2. Cancer

Proptosis can indicate early-stage primary cancers that develop around the eyes, such as ocular melanoma or carcinoma. Metastatic cancers, such as breast cancer, can also lead to eye protrusion. A notable case in 2018 illustrated how proptosis and headaches could signal multiple myeloma, a type of blood cancer.

3. Physical Trauma

Traumatic injuries can lead to proptosis, as illustrated by a case study involving a football player who experienced eye displacement due to helmet impact. Such trauma can result in retrobulbar hematoma—accumulated blood behind the eyeball—which can cause the eye to bulge.

4. Infections

Severe sinus infections may lead to conditions like orbital cellulitis or abscesses, resulting in swelling that applies pressure behind the eye, potentially triggering proptosis.

5. Blood Vessel Disorders

A rare condition, granulomatosis with polyangiitis, can affect blood vessels and contribute to proptosis alongside other ocular complications.

How is Proptosis Diagnosed?

Seeking prompt medical attention is crucial when noticing bulging eyes to prevent permanent vision complications. An eye care specialist typically diagnoses proptosis using an exophthalmometer, measuring the degree of eyeball protrusion. They will also inquire about the patient's medical history and other symptoms. Diagnostical tests may include:

• Thyroid function and autoantibody tests
• Renal function tests and C-reactive protein levels
• Nasal swabs and blood cultures in cases of suspected infection

Imaging techniques such as CT or MRI scans can assist in determining:

• The presence of tumors
• The extent of inflammation around the eye
• Potential damage to the optic nerve

What are the Treatment Options for Proptosis?

Treatment approaches for proptosis depend on the causative factors, initiated through comprehensive examinations to identify the underlying issues.

General Management

Some general management strategies for bulging eyes may include:

• Steroid injections to diminish inflammation
• Eye drops to alleviate irritation and dryness
• Wearing sunglasses to mitigate light sensitivity
• Avoiding irritants such as dust

Specific TED Treatment

If proptosis relates to thyroid dysfunction, treatment strategies for hyperthyroidism may encompass:

• Medications like teprotumumab (Tepezza) or methimazole (Northyx)
• Radioactive iodine therapy
• Surgical removal of the thyroid gland

Surgical Options

For severe cases of proptosis, surgical interventions like orbital decompression and extraocular muscle repair may be recommended, improving vision in up to 82% of cases, alongside tumor removal if necessary.

Cancer Treatments

In cancer cases, surgical interventions may be complemented by:

• Radiation therapy
• Chemotherapy
• Immunotherapy
• Targeted treatments

What is the Prognosis for Proptosis?

Early intervention for proptosis is vital to reduce the risk of severe complications. Many mild cases can resolve with supportive treatment, with about 66% improving within six months. It is noteworthy that 95% of individuals with thyroid-related proptosis experience recovery without persistent vision loss, although roughly 5% may face lasting double vision or vision impairment.

Conclusion

Proptosis signifies abnormal eye bulging, primarily driven by thyroid issues but potentially resulting from other conditions like cancer, injuries, or infections. Prompt consultation with an eye specialist is crucial in managing proptosis effectively. Early treatment significantly improves the likelihood of preserving vision and addressing the underlying causes.