Proptosisproptose

Proptosis, also known as exophthalmos, is the forward displacement of one or both eyeballs within the orbit. The appearance can be unilateral or bilateral and may result from increased orbital volume, tissue swelling, or restricted orbital movement. The term proptosis is the standard medical term; some sources may use exophthalmos. The form “proptose” is not widely used in modern medical literature.

Common causes include Graves' disease (thyroid eye disease) with retrobulbar tissue expansion, orbital cellulitis or abscess, inflammatory orbital syndromes, vascular abnormalities such as carotid-cavernous fistula, orbital tumors (e.g., lymphoma, meningioma), traumatic intraorbital hemorrhage or fracture, and less frequently congenital anomalies or inflammatory conditions.

Symptoms often include a visibly protruding eye, diplopia (double vision), eyelid swelling, redness, pain, tearing, and potential reductions in vision. Patients may have restricted eye movements and, in cases of optic nerve compression, rapidly worsening vision.

Evaluation requires a focused ophthalmic examination, measurement of proptosis (often with an exophthalmometer), assessment of visual acuity and color vision, and imaging to define the cause. CT or MRI clarifies orbital contents, mass effects, inflammation, or vascular lesions. Blood tests may assist in diagnosing thyroid eye disease or other systemic conditions. Urgent imaging and intervention are required if optic nerve compression or orbital infection is suspected.

Management targets the underlying cause. Orbital cellulitis or abscess requires antibiotics or drainage; inflammatory syndromes may respond to corticosteroids; Graves' disease may involve steroids, selenium, radiotherapy, or orbital decompression; tumors and vascular lesions require oncologic or endovascular treatment, respectively. Prompt treatment improves outcomes and reduces the risk of permanent vision loss.

Prognosis varies with cause and timeliness of treatment. Complications can include exposure keratopathy, corneal ulcers, and irreversible vision loss if the optic nerve is compromised. See also exophthalmos, ptosis, orbital apex syndrome.