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Exophthalmos and Thyroid Eye Disease

Being a nurse, you are the medical professional who interacts the most with patients and their families. As important as it is to provide clinical care to your patients, it is also crucial for you to offer patient education. Patients and their families who are well-informed about their health conditions have a better chance of a positive health outcome. As a nurse, it is important to learn as much as possible about various health problems you will encounter in patients during your career to provide better care and education.

A fairly uncommon condition you may encounter with patients is exophthalmos. Also called bulging eyes and proptosis, exophthalmos is a condition that can significantly impact a patient visually and psychologically. The condition is marked by a protrusion of the eyes from their normal positions, indicating a sign of a severe medical condition, typically thyroid eye disease.

Some people are naturally born with eyes that slightly protrude more than usual. However, others can develop bulging eyes due to an underlying health condition. In this Fast CE For Less guide, we will discuss the most important facts surrounding exophthalmos, what causes it, and available treatments.

What Is Exophthalmos?

Exophthalmos is the name given to describe when a person’s eyeballs protrude out of their eye sockets more than they should. The condition can affect one or both eyes. If it affects one eye, it is considered unilateral. If both eyes are protruding more than they should from their eye sockets, it is called bilateral exophthalmos. Protruding eyes are a cosmetic concern. However, bulging eyes can also cause significant discomfort and problems with vision.

When the eyes bulge out of the eye sockets, the white areas above the iris can become visible. Typically, you should only be able to see the white part of the eye above the iris when a person lifts their eyelid. Exophthalmos is not a disease itself. Rather, it is a condition that happens due to various possible causes, including underlying health concerns that require medical attention.

As a nurse, recognizing exophthalmos in patients is necessary because early detection is crucial to manage it effectively. When a patient develops bulging eyes, besides the obvious change in their appearance, they may also report an inability to close their eyes properly, issues with their vision, and discomfort.

Bulging Eyes and Thyroid Eye Disease

Thyroid Eye Disease, or TED, is an autoimmune condition. Sometimes, a person’s immune system can start attacking their own body. If a person has TED, their immune system begins attacking the cells in the tissues surrounding their eyes. This leads to swelling and inflammation. Thyroid eye disease is typically associated with a person’s thyroid health, particularly with disorders like hyperthyroidism.

Symptoms and Effects on the Eye of Thyroid Eye Disease

A person with TED can experience various symptoms impacting one or both eyes. Some of the common symptoms of thyroid eye disease include light sensitivity, increased tears, pain in the eyes, and a feeling of grittiness. When TED progresses untreated, it can lead to bulging eyes, or exophthalmos.

Thyroid eye disease often occurs when a person has issues with their thyroid gland. This is most common when a person has Grave’s disease. The thyroid gland is responsible for regulating a person’s metabolism by releasing certain hormones. When the thyroid gland becomes overactive, it is called hyperthyroidism. Due to the thyroid gland becoming overactive, the body’s immune system can start attacking tissues in the body.

Graves’ Disease 

Graves’ disease is the most common autoimmune disorder related to exophthalmos. It happens when the thyroid gland becomes overactive and produces too much thyroid hormone. Graves’ disease and hyperthyroidism have several symptoms, including:

  • Irregular periods in women
  • Hand tremors
  • Sleep problems
  • Goiter
  • Weight loss

Impact on Vision and Eyes

When Graves’ disease begins to affect the eye tissue and muscle, it can inflame the eye sockets and start to swell. Due to the swelling and inflammation, the eyelids can retract, making the eyes seem like they are protruding out of the sockets. It can also lead to dryness or irritation in the eyes, double or blurry vision, a sense of pressure or pain in the eyes, and light sensitivity.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, around a third of people with Graves’ disease can develop these symptoms, and 5% of them may have more severe problems. It is necessary for patients to seek help from an expert immediately to begin treating the underlying health condition to avoid severe symptoms.

Other Conditions that Can Cause Bulging Eyes

While thyroid eye disease and Graves’ disease are the most common reasons for a person to develop exophthalmos, several other conditions can cause bulging eyes, including:

  • Injuries that result in bleeding behind the eye
  • Sarcoidosis and other connective tissue diseases
  • Non-Hodgkin’s lymphoma
  • Cancers developing in soft tissues
  • Leukemia
  • Neuroblastoma

Diagnosing the Underlying Cause of Exophthalmos

When a person develops unilateral or bilateral exophthalmos, it is necessary to consult with an expert immediately. Because bulging eyes can occur from various reasons, it is necessary for a patient to talk to a healthcare professional and share their medical history to find the underlying reason. When a healthcare professional understands the underlying reason for the condition, they can recommend treatment to patients to treat and manage the condition.

Treatments for Bulging Eyes

Depending on what is causing exophthalmos, the treatments for bulging eyes can vary significantly. After taking a patient’s medical history, conducting tests, and diagnosing the underlying cause, a healthcare professional may treat bulging eyes with any of the following:

  • Eye drops
  • Eye surgery
  • Chemotherapy
  • Corticosteroids
  • Antibiotics

If a person’s exophthalmos is caused by Graves’ disease, a healthcare professional may recommend treatments like antithyroid medications or beta-blockers to prevent hyperthyroidism. Depending on the severity, a healthcare provider may also use surgery or radioactive iodine to remove or destroy the thyroid gland. A healthcare provider may also prescribe replacement thyroid hormone to ensure the body can function properly.

Remember, bulging eyes are more than a mere aesthetic concern. Exophthalmos is typically a sign of more severe health conditions that a person must treat. 

If you have not completed your continuing competency requirements to renew your license and want to learn more about providing care for your patients, online nursing CEUs offered by Fast CE For Less can be of great help.

To access flexible and affordable nursing continuing education courses and state bundles, visit www.fastceforless.com.

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