Among the variety of ophthalmic diseases, two categories should be distinguished. Some pathologies can be recognized only on special diagnostic equipment, while others are clearly distinguishable due to physical disorders in the visual apparatus. Exophthalmos is a disorder that is noticeable to the naked eye. For him, a protrusion of the eyeball or a shift to one side is typical. In today's article we will consider why this ailment arises, what methods of its treatment exist.
Exophthalmos - what is it?
This term refers to a rather rare disease. In everyday life, you can meet another name - "eye-eye". Its development is caused by a pathological increase in the number of retrobulbar tissues located in the orbit. The cause of this violation, in turn, is inflammatory, neurodystrophic or traumatic processes. Manifestations of exophthalmos can be observed at any age.
The first case of buccalis in medicine was recorded at the end of the 18th century and was caused by a thyroid disease. However, the pathology received a detailed description only in the middle of the 20th century. Since that time, its active study began. Many doctors believe that exophthalmos is a manifestation of one or more diseases, and not an independent violation. The former are not always associated with the visual apparatus, sometimes the reason lies in the functional disorder of other organs. Therefore, only differential diagnosis allows you to identify the source of the disease, correctly select the therapy.
Main reasons
It is immediately necessary to note that various disturbances in the functioning of the visual organs cannot be the cause of exophthalmos. On the other hand, a disease left without timely treatment often provokes the development of complications. Among them, the most dangerous is complete loss of vision.
Numerous studies of patients with this ailment have confirmed that damage to the eye tissues characteristic of exophthalmos is caused by a malfunction in the immune system. In this case, adipose tissue in the orbit swells in the patient, then the motor muscles join this process. This phenomenon affects both eyes, but initially appears on only one.
Among other causes of the pathological process, doctors distinguish the following:
- inflammation of the blood vessels, lacrimal glands of the eyes;
- congenital glaucoma;
- varicosity of the orbital veins;
- various injuries causing hemorrhages;
- tumors of the orbits;
- paralysis of the external muscles of the eye.
Also, the causes of the disease may be local processes. For example, diffuse toxic goiter, hypothalamic syndromes, aneurysms, thrombosis, hydrocephalus.
Clinical picture
The severity of symptoms of exophthalmos depends on the degree of protrusion of the eye. A slightly distinguishable violation practically does not cause the patient discomfort. As the disease progresses, the clinical picture changes, supplemented by the following symptoms:
- swelling and redness of the sclera;
- decreased visual acuity;
- double vision.
Due to the displacement of the eyeball, the patient loses the opportunity to close the palpebral fissure. Therefore, he gradually develops keratopathy. Pathology leads to infection and ulceration of the cornea.
Exophthalmos classification
The disease is usually classified into imaginary and true. In the first case, the pathological process develops against the background of severe myopia. A more serious variant of the disease is true exophthalmos. What it is? The disease occurs due to tumor or inflammatory disorders. It can occur both in acute and in chronic form.
True exophthalmos, in turn, is divided into the following types:
- constant;
- throbbing;
- progressive malignant;
- intermittent.
There is also unilateral exophthalmos and bilateral (affects both eyes).
According to another classification, three types of buccal eye are distinguished: thyrotoxic, edematous, and endocrine myopathy. Now in more detail we will consider what each of them represents.
Thyrotoxic exophthalmos
This type of disease is found mainly in women. Its development is preceded by thyroid hormone poisoning. Soft tissues are not involved in the pathological process. The upper muscles of the eye orbit, which are responsible for the movement of the eyelid, are spasmodic and noticeably increase in size.
As the disease develops, a significant expansion of the palpebral fissure occurs. At first, the changes are asymmetric. Gradually, the palpebral fissure becomes deeper and wider. At the same time, other ophthalmic disorders appear: it becomes difficult for the patient to blink, to look at objects located nearby. Outwardly, it seems that such a person has “eyes on the roll”.
Lacrimal fluid deficiency provokes an abnormal gloss of proteins. When the patient every time tries to close his eyes, the upper eyelids begin to twitch. On the movement of the pupil and cornea, their inhibited reaction is observed.
Edematous exophthalmos
The reasons for the development of this form of the disease are still poorly understood. To date, only 70% of patients have a clear etymology. In half the cases, the pathological process is endocrine in nature. In 10%, the disease develops against a background of infection. The remaining 10% is attributed by doctors to the patient’s history and lifestyle.
The edematous form is characterized by a strong protrusion of the eyeball. In most cases, the pathology is bilateral in nature. Only 10% of patients have exophthalmos of one eye. At the same time, the pain can be so strong that patients are prescribed narcotic painkillers.
If treatment is not started in a timely manner, the disease can lead to keratitis. This is an inflammation of the membrane of the cornea, in which vision is deteriorating rapidly.
Endocrine myopathy
The nature of this form of the disease is closely related to hormonal changes in the thyroid gland. Its development is promoted either by excessive release of hormones, or their acute deficiency. Among the main causes of the disorder, doctors call stress, radiation exposure, a genetic predisposition.
The main sign of endocrine myopathy is a visual disorder, when all objects begin to literally bifurcate. Then there is a restriction of the mobility of the eyeball. After about 4-5 months, fibrosis develops - the uncontrolled growth of intraocular tissues.
Diagnostic Methods
If you suspect exophthalmos, you should immediately contact the nearest ophthalmology department. Only a qualified specialist can diagnose a violation and choose competent therapy. An ophthalmologist deals with this issue. To confirm the disease, it is enough for him to conduct one study - exophthalmometry.
During the procedure, a special ruler is used. On a scale with divisions, the doctor determines the size of the cornea, compares the tops of its protrusions. After that, the sizes of the palpebral fissure, the presence of other diseases in which complete closure of the eyelids is impossible, are taken into account.
Depending on the results of the study, the ophthalmologist determines the severity of the pathological process. When the size of the cornea exceeds 20 mm, and the difference between its highest points is more than 2 mm, they speak of exophthalmos. What is it, why does it arise and how to deal with it - the doctor should answer these questions right at the reception.
In parallel with exophthalmometry, the patient is prescribed a number of additional studies (ultrasound of the thyroid gland, hormone analysis, check of the immune system, etc.). Based on the results of a comprehensive diagnosis, the ophthalmologist selects treatment.
Therapy options
Bulging eyes or exophthalmos is a serious pathology that requires medical or even surgical intervention. It is not possible to normalize the functioning of the visual apparatus, remove inflammation from the muscles and return the eyeballs to their places through recipes of folk doctors. An endocrinologist and an ophthalmologist should deal with the treatment of the disease, and if necessary, a surgeon. Therapy can take from several months to 2-3 years.
Treatment of exophthalmos is always prescribed individually. In this case, the doctor must take into account the severity of the pathology, the patient’s history, the presence of concomitant ailments. Therapy is considered completed successfully if it was possible to stop the main symptoms.
Various drugs are used to combat the disease. For example, to eliminate puffiness, appoint "Lasiks", "Furosemide" or "Diacarb". To normalize cellular metabolism, Actovegin and Proserin are used. If it is necessary to stop the inflammation, the doctor may prescribe Dexamethasone or Prednisolone. With serious problems with the thyroid gland, the use of hormonal drugs is required. Their intake should be strictly controlled by a doctor.
When conservative treatments do not produce the desired results, surgery is recommended. Standard surgery involves the expansion of the orbit by removing the orbital walls. Additionally relax the eye muscles.
Prognosis for recovery
The causes of bulging eyes in each case may be different. Therefore, the prognosis for recovery will depend on the following factors:
- timeliness of diagnosis;
- the severity of the pathology;
- the correctness of the prescribed treatment;
- individual characteristics of the body.
With mild to moderate exophthalmos, the prognosis is favorable. In more serious cases, the help of surgeons may be required.
Prevention Methods
For a disease such as exophthalmos, the main symptom is "eyes on the roll." This is a rather unpleasant disorder that requires competent treatment. Is it possible to prevent its occurrence?
According to leading ophthalmologists, the basis for the prevention of this ailment is a healthy lifestyle. It is important to eat right and rationally, try to eradicate all addictions, and avoid stressful situations. In the presence of any ophthalmic diseases, it is necessary to start therapy in a timely manner and not to neglect the recommendations of the attending physician.
The organs of vision and the head should be protected from traumatic injuries. If you suspect a thyroid pathology, you should immediately consult an endocrinologist and undergo an examination.