Exophthalmos
| Classification according to ICD-10 | |
|---|---|
| H05.2 | Exophthalmos |
| H06.2 * | Exophthalmos in thyroid dysfunction |
| (E05.0 +) | (Hyperthyroidism with diffuse goiter, Graves disease) |
| ICD-10 online (WHO version 2019) | |
The exophthalmos (synonyms: protrusio bulbi, ophthalmoptosis, ophthalmopathy , popularly "bulging eye " and "bulging eye " ) is the pathological protrusion of the eyeball from the eye socket ( orbit ).
Symptoms
Patients with pronounced exophthalmos are very impressive because they make a "frightened" impression with their apparently wide-open eyes and thus frighten the viewer.
- The eyeball protrudes on one or both sides
- z. T. pain
- Double vision due to the influence of the eye muscles and the orbital nerves (so-called exophthalmic ophthalmoplegia of the oculomotor nerve )
- Eyelid swelling
- Drying out of the cornea
- possibly ulcerations and inflammation of the cornea
root cause
Endocrine exophthalmos
(Syn. Endocrine orbitopathy )
In Graves' disease , Ord thyroiditis / Hashimoto's thyroiditis , autoimmune inflammations in the area of the orbit , especially in the orbital fatty tissue , can occur during the disease . This inflammation leads to swelling of the retrobulbar tissue and proliferation. The exophthalmos is bilateral in the majority of cases.
Exophthalmus pulsans
A pulsating exophthalmos is found in mostly traumatic arteriovenous short circuits between orbital veins and orbital arteries or the cavernous sinus .
Orbital phlegmon
In orbital phlegmon , the tissue of the orbit is diffusely inflamed. Due to the inflammation, the orbital tissue swells and the eyeball is pushed forward.
Exophthalmos in orbital tumors
Benign and malignant tumors occur in the area of the eye socket (e.g. benign: hemangioma , neurinoma ; malignant: neuroblastoma , retinoblastoma, etc.). Due to the tumor growth, the eyeball is pushed forward. Also metastases or participation of the orbit at most malignant systemic diseases (for. Example, lymphoma , leukemia , histiocytosis X ) occur. The exophthalmos is usually one-sided.
Intermittent exophthalmos
This is an exophthalmos that is dependent on the posture of the head in congenital or acquired varicose veins in the area of the orbit. Depending on the position of the head, congestion occurs in the varicose vessel with a protruding eyeball.
Exophthalmos in retrobulbar hematoma
If, after a blunt trauma, subconjunctival hemorrhage that is not limited to the rear occurs, a retrobulbar hematoma, i.e. a bruise behind the eyeball, can develop. This too can lead to exophthalmos.
Diagnosis
Clinical examination
You look at both eyeballs from behind and above on the seated patient and can thus estimate the extent and determine a side difference.
When looking down, as the Berlin ophthalmologist Albrecht von Graefe had observed, the upper eyelid remains behind in Graves' disease ( Graefe sign ).
Exophthalmometer
The exophthalmos and its progression / regression can be measured using an exophthalmometer .
Imaging
With the help of CT and MRT , the structures of the orbit can be visualized. This can be used to diagnose tumors or inflammation. Also, the ultrasound is used for the diagnosis of orbit.
Laboratory tests
- Endocrine exophthalmos: examinations of the thyroid function ( thyroxine , triiodothyronine , TRH , TSH , autoantibodies )
- On suspicion of orbit - Cellulitis (study of inflammatory markers: CRP , leukocytes and Others..)
Auscultation
In the case of arteriovenous short circuits, a pulse- synchronous noise can be auscultated.
Severity classification
- Grade I : retraction of the upper eyelid ( Dalrymple phenomenon ), weakness of convergence ( Moebius sign ).
- Grade II : Involvement of the (externally assessable) connective tissue : eyelid swelling, chemosis , tears, photophobia
- Grade III : protrusion of the eyeball with and without eyelid swelling (quantifiable by using an exophthalmometer )
- Grade IV (with blockages of the eye muscles): blurred images or double images
- Grade V (with corneal involvement): mostly desiccating eyeball ( lagophthalmos ) with haze and surface damage ( ulceration ) of the cornea ( cornea )
- Grade VI (involvement of the optic nerve ): loss of vision or loss of vision
therapy
The therapy for exophthalmos depends on the underlying causal disease. Phlegmons or abscesses may need to be relieved and treated with antibiotics . Tumors or retrobulbar fat can be addressed surgically .
Complications
- Malignant exophthalmos: Malignant exophthalmos results in painful and progressive protrusion of the eyeball with poor eyelid closure ( lagophthalmos ) and drying out of the cornea ( xerophthalmia ).
- Corneal ulcerations
- Conjunctivitis
- Increase in intraocular pressure (see glaucoma )
See also
Web links
Individual evidence
- ↑ Ferdinand Sauerbruch : Lecture on Basedow's disease. In: Ferdinand Sauerbruch, Hans Rudolf Berndorff : That was my life. Kindler & Schiermeyer, Bad Wörishofen 1951; cited: Licensed edition for Bertelsmann Lesering, Gütersloh 1956, pp. 262–271, here: p. 263.
