Exophthalmos

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Exophthalmos
Girl aged 17 years with marked proptosis Wellcome L0062481.jpg
Bilateral exophthalmos in a 17-year old girl with facial symptoms of Pfeiffer syndrome
Specialty Ophthalmology   OOjs UI icon edit-ltr-progressive.svg

Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in an orbital tumor). Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma.

Contents

In the case of Graves' disease, the displacement of the eye results from abnormal connective tissue deposition in the orbit and extraocular muscles, which can be visualized by CT or MRI. [1]

If left untreated, exophthalmos can cause the eyelids to fail to close during sleep, leading to corneal dryness and damage. Another possible complication is a form of redness or irritation called superior limbic keratoconjunctivitis, in which the area above the cornea becomes inflamed as a result of increased friction when blinking. The process that is causing the displacement of the eye may also compress the optic nerve or ophthalmic artery, and lead to blindness.

Causes

According to the NCBI, the following conditions feature exophthalmos: [2]

Exophthalmos in Acrocephalosyndactyly type 1 Casazza 1.jpg
Exophthalmos in Acrocephalosyndactyly type 1
Exophthalmos in cloverleaf skull Davis Oxycephalus 1.jpg
Exophthalmos in cloverleaf skull
Exophthalmos in Crouzon syndrome Crouzon Syndrome 5.jpg
Exophthalmos in Crouzon syndrome
Exophthalmos in microcephaly (with turricephaly) Turricephalus (microcephalic type).jpg
Exophthalmos in microcephaly (with turricephaly)

Anatomy

Proptosis is the anterior displacement of the eye from the orbit. Since the orbit is closed off posteriorly, medially and laterally, any enlargement of structures located within will cause the anterior displacement of the eye. [3] Swelling or enlargement of the lacrimal gland causes inferior medial and anterior dislocation of the eye. This is because the lacrimal glands are located superiorly and laterally in the orbit. [3]

Diagnosis

Measurement

Measurement of the degree of exophthalmos is performed using an exophthalmometer.

Most sources define exophthalmos/proptosis as a protrusion of the globe greater than 18 mm. [1]

The term exophthalmos is often used when describing proptosis associated with Graves' disease. [4]

Animals

Exophthalmos in a Pug Exophthalmos in pug.JPG
Exophthalmos in a Pug

Exophthalmos is commonly found in dogs. It is seen in brachycephalic (short-nosed) dog breeds because of the shallow orbit. It can lead to keratitis secondary to exposure of the cornea. Exophthalmos is commonly seen in the pug, Boston terrier, Pekingese, and shih tzu. It is a common result of head trauma and pressure exerted on the front of the neck too hard in dogs. In cats, eye proptosis is uncommon and is often accompanied by facial fractures. [5]

About 40% of proptosed eyes retain vision after being replaced in the orbit, but in cats very few retain vision. [6] Replacement of the eye requires general anesthesia. The eyelids are pulled outward, and the eye is gently pushed back into place. The eyelids are sewn together in a procedure known as tarsorrhaphy for about five days to keep the eye in place. [7] Replaced eyes have a higher rate of keratoconjunctivitis sicca and keratitis and often require lifelong treatment. If the damage is severe, the eye is removed in a relatively simple surgery known as enucleation of the eye.

The prognosis for a replaced eye is determined by the extent of damage to the cornea and sclera, the presence or absence of a pupillary light reflex, and the presence of ruptured rectus muscles. The rectus muscles normally help hold the eye in place and direct eye movement. Rupture of more than two rectus muscles usually requires the eye to be removed, because significant blood vessel and nerve damage also usually occurs. [7] Compared to brachycephalic breeds, dochilocephalic (long-nosed) breeds usually have more trauma to the eye and its surrounding structures, so the prognosis is worse. [8]

See also

Related Research Articles

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<span class="mw-page-title-main">Orbit (anatomy)</span> Cavity or socket of the skull in which the eye and its appendages are situated

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Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction of cranial nerve VI, which is responsible for causing contraction of the lateral rectus muscle to abduct the eye. The inability of an eye to turn outward, results in a convergent strabismus or esotropia of which the primary symptom is diplopia in which the two images appear side-by-side. Thus, the diplopia is horizontal and worse in the distance. Diplopia is also increased on looking to the affected side and is partly caused by overaction of the medial rectus on the unaffected side as it tries to provide the extra innervation to the affected lateral rectus. These two muscles are synergists or "yoke muscles" as both attempt to move the eye over to the left or right. The condition is commonly unilateral but can also occur bilaterally.

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Corneal ulcer, also called keratitis, is an inflammatory or, more seriously, infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma. It is a common condition in humans particularly in the tropics and in farming. In developing countries, children afflicted by vitamin A deficiency are at high risk for corneal ulcer and may become blind in both eyes persisting throughout life. In ophthalmology, a corneal ulcer usually refers to having an infection, while the term corneal abrasion refers more to a scratch injury.

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Exposure keratopathy is medical condition affecting the cornea of eyes. It can lead to corneal ulceration and permanent loss of vision due to corneal opacity.

References

  1. 1 2 Owen Epstein; David Perkin; John Cookson; David P de Bono (April 2003). Clinical examination (3rd ed.). St. Louis: Mosby. ISBN   0-7234-3229-5.
  2. "Proptosis (Concept Id: C0015300)". www.ncbi.nlm.nih.gov. Retrieved 2024-03-24.
  3. 1 2 Mitchell, Richard N (2011). "Eye". Pocket companion to Robbins and Cotran pathologic basis of disease (8th ed.). Philadelphia, PA: Elsevier Saunders. ISBN   978-1-4160-5454-2.
  4. Exophthalmos (Proptosis) at eMedicine
  5. "Prolapse of the Eye". The Merck Veterinary Manual. 2006. Retrieved 2007-03-23.
  6. Gelatt, Kirk (2002). Treatment of Orbital Diseases in Small Animals. Proceedings of the 27th World Congress of the World Small Animal Veterinary Association. Retrieved 2007-03-23.
  7. 1 2 Gelatt, Kirk N., ed. (1999). Veterinary Ophthalmology. Lippincott Williams & Wilkins. ISBN   978-0-683-30076-5.[ page needed ]
  8. Bjerk, Ellen (2004). Ocular Injuries in General Practice. Proceedings of the 29th World Congress of the World Small Animal Veterinary Association. Retrieved 2007-03-23.