Exophthalmos [Proptosis]
Exophthalmos—the abnormal protrusion of one or both eyeballs—may result from hemorrhage, edema, or inflammation behind the eye; extraocular muscle relaxation; or space-occupying intraorbital lesions and metastatic tumors. This sign may occur suddenly or gradually, causing mild to dramatic protrusion. Occasionally, the affected eye also pulsates. The most common cause of exophthalmos in adults is dysthyroid eye disease.
Exophthalmos is usually easily observed. However, lid retraction may mimic exophthalmos even when protrusion is absent. Similarly, ptosis in one eye may make the other eye appear exophthalmic by comparison. An exophthalmometer can differentiate these signs by measuring ocular protrusion.
History and physical examination
Begin by asking when the patient first noticed exophthalmos. Is it associated with pain in or around the eye? If so, ask him how severe it is and how long he has had it. Then ask about recent sinus infection or vision problems. Take the patient's vital signs, noting a fever, which may accompany eye infection. Next, evaluate the severity of exophthalmos with an exophthalmometer. (See Detecting unilateral exophthalmos.) If the eyes bulge severely, look for cloudiness on the cornea, which may indicate ulcer formation. Describe any eye discharge and observe for ptosis. Then check visual acuity, with and without correction, and evaluate extraocular movements. Palpate the patient's thyroid for enlargement or goiter.
Medical causes
Cavernous sinus thrombosis.Usually, cavernous sinus thrombosis causes the sudden onset of pulsating, unilateral exophthalmos. Accompanying it may be eyelid edema, decreased or absent pupillary reflexes, and impaired extraocular movement and visual acuity. Other features include a high fever with chills, papilledema, a headache, nausea, vomiting, somnolence and, rarely, seizures.
Dacryoadenitis.Unilateral, slowly progressive exophthalmos is the most common sign of dacryoadenitis. Assessment may also reveal limited extraocular movements (especially on elevation and abduction), ptosis, eyelid edema and erythema, conjunctival injection, eye pain, and diplopia.
Foreign body in the eye.When a foreign body enters the eye, exophthalmos may accompany other signs and symptoms of ocular trauma, such as eye pain, redness, and tearing.
Hemangioma.This orbital tumor produces progressive exophthalmos, which may be mild or severe, unilateral or bilateral. Other signs and symptoms include ptosis, limited extraocular movements, and blurred vision.
Lacrimal gland tumor.Exophthalmos usually develops slowly in one eye, causing its downward displacement toward the nose. The patient may also have ptosis and eye deviation and pain.
Leiomyosarcoma.Leiomyosarcoma is characterized by slowlydeveloping, unilateral exophthalmos. Other effects include diplopia, impaired vision, and intermittent eye pain.
Orbital cellulitis.Commonly the result of sinusitis, this ocular emergency causes the sudden onset of unilateral exophthalmos, which may be mild or severe. Orbital cellulitis may also produce a fever, eye pain, a headache, malaise, conjunctival injection, tearing, eyelid edema and erythema, purulent discharge, and impaired extraocular movements.
Orbital choristoma.A common sign of this benign tumor, progressive exophthalmos may be associated with diplopia and blurred vision.
Orbital emphysema.Air leaking from the sinus into the orbit usually causes unilateral exophthalmos. Palpation of the globe elicits crepitation.
Parasite infestation.Usually, parasite infestation causes painless, progressive exophthalmos in one eye that may spread to the other eye. Associated findings include limited extraocular movement, diplopia, eye pain, and impaired visual acuity.
Scleritis (posterior).The gradual onset of mild to severe unilateral exophthalmos is common with scleritis. Other signs and symptoms include severe eye pain, diplopia, papilledema, limited extraocular movement, and impaired visual acuity.
Thyrotoxicosis.Although a classic sign of thyrotoxicosis, exophthalmos is absent in many patients. It's usually bilateral, progressive, and severe. Associated ocular features include ptosis, increased tearing, lid lag and edema, photophobia, conjunctival injection, diplopia, and decreased visual acuity. Other findings include an enlarged thyroid, nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremors, palpitations, and tachycardia.
Nursing considerations
▪ Because exophthalmos usually makes the patient self-conscious, provide privacy and emotional support.
▪ Protect the affected eye from trauma, especially drying of the cornea.
▪ Don't place a gauze eye pad or other object over the affected eye; removal could damage the corneal epithelium.
▪ If necessary, refer him to an ophthalmologist for a complete examination.
▪ Prepare the patient for blood tests, such as a thyroid panel and a white blood cell count.
Patient teaching
▪ Teach ways to protect the eye from trauma, wind, and dust.
▪ Discuss the proper application of lubricants to the eye.
▪ Explain the underlying cause of the patient's exophthalmos and its treatment.
Pictures
![Exophthalmos [Proptosis] - 5589.1.png](/bookimages/16/5589.1.png)
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Goiter
Read excerpts from these other book chapters related to Goiter:
Medical Books Excerpts
- Thyroid Nodule
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Goiter
- "The 5-Minute Pediatric Consult" (2008)
- [ read ]
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Goiter
» Next page: EXOPHTHALMOS (Differential Diagnosis in Primary Care)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
