thyroid eye disease – Ask Eye Doc

Written by: Dr. Stephanie Mulick, O.D. I was so confused when someone told me they had a popped eye. What does that mean? I still don’t know but I can assume a couple of things. “My eye popped!” could it be Exophthalmos or Proptosis Exophthalmos or Proptosis is a condition in which one or both eyes protrude from the orbit, giving an appearance of bulging eyes. The most common cause of bilateral exophthalmos is Grave’s disease. Grave’s Disease or Thyroid Eye Disease: Grave’s disease is a condition that results in an over-active thyroid gland causing more thyroid hormone to be produced than what is needed (hyperthyroidism). The symptoms of hyperthyroidism can include weight loss, frequent bowel movements, trouble sleeping, heat intolerance and bulging eyes. It is more common in females than males and usually presents between the ages of 30-50. It is more likely to develop in people with a family history or those with an autoimmune disease. Work up/Examination History of thyroid diseaseCigarette smoking: increases the risk for ocular symptomsHertel Exophthalmometer: to measure the amount of proptosisExtraocular motility test: to determine if there is limited eye movementComplete health evaluation of the eyes including a dilated eye examThyroid blood tests: T3, T3RU, T4, and TSHCT scanCommunication between Endocrinologist and Ophthalmologist for proper treatment The following video is from Dr. Tayani a fellowship trained Oculoplastic surgeon. https://youtu.be/hSi9L-Lmx_U Several other conditions can cause Exophthalmos including: CystsTraumaHemorrhagesAneurysmInfectionNeoplasm: mass or tumorPseudotumorSarcoidosis: an inflammatory condition which causes granulomas to build up in the bodyIncreased intracranial pressure A Unilateral proptosis can be caused by an increase in the volume of the tissue behind one eye. Conditions that can cause eyes to protrude forward: ConditionLaterality (unilateral or bilateral)Age of OnsetGrave's DiseaseUsually Bilateral Rarely Unilateral20-50 years old females more than malesCongenital Craniofacial synostosisBilateralAt BirthOsteitis deformans or Paget DiseaseBilateralOver 55 years old males more than femalesChildhood Rickets Bilateral6-36 months oldDermoid cystUnilateralBirth to 5 years oldNon-traumatic Orbital hemorrhage (very rare)Unilateral20-78 years oldTumorsUsually Unilateral/ rarely BilateralVaries depending on etiologypseudotumor/Idiopathic intracranial hypertensionUnilateralMost common in obese women age 11-58HistiocytosisBilateral1-15 years oldTraumatic aneurysmUnilateralMost common in females age 30-60AmyloidosisBilateral and Unilateral60-70 years oldSarcoidosisUsually Unilateral/ rarely BilateralTypically age 25-40, but sometimes olderCarotid-Cavernous Fistula: spontaneous (rare) and traumaticUsually Unilateral/ rarely Bilateral20 years old and upCavernous sinus thrombosis (extremely rare condition)UnilateralMost common in females under 50 years old Conclusion: I still don’t know exactly what “popped eye” means, but two conditions come to mind: Exophthalmos/Proptosis “bulging eye” which can be caused by several conditions, the most common of which is Grave’s disease. a subconjunctival hemorrhage or broken blood vessel of the eye is simply just a bruise of the eye requiring no treatment, review my post on subconjunctival hemorrhage for more information.