Exophthalmos

Japanese: 眼球突出 - がんきゅうとっしゅつ（英語表記）Exophthalmos
Exophthalmos

What is the disease?

This condition makes the eyes appear to be bulging. There are many diseases that can cause this condition, and it is one of the symptoms.

In people with severe myopia, the diameter of the eyeball increases, making the eyes appear to bulge, but this is not called exophthalmos.

What is the cause?

The eyeball is an extremely important organ, so it is tightly protected by seven bones. Eye socket ( Cancer ) However, if any substances form inside the eye socket, they cannot spread to the surrounding hard bone, so they push the eyeball forward, causing it to bulge.

There are many different causes of exophthalmos. The most common diseases that cause exophthalmos are Thyroid eye disease ( Factory competition ) This condition is also called Graves' disease. Inflammation of the extraocular muscles that move the eyes can also cause bilateral exophthalmos. Bilateral exophthalmos can also be caused by congenital bone abnormalities.

Unilateral exophthalmos can be Orbital cellulitis ( Cancer Prevention Week ) or Orbital tumors ( Cancer ) The following are typical examples. Trauma can also cause exophthalmos.

How symptoms manifest

In cases of Graves' disease or orbital tumors, the eyeballs will protrude gradually, but the patient may suddenly notice it. In cases of orbital cellulitis or trauma, the eyeballs will protrude suddenly.

The direction of exophthalmos also depends on the location of the lesion. In Graves' disease, the eyeballs protrude forward. Lacrimal gland tumors ( Warrior warrior ) In this condition, the eyeball bulges downward and inward, and vision may decrease, eye movement may become difficult, and pain may occur.

Testing and diagnosis

To measure the degree of exophthalmos, a Hertel exophthalmometer is used to record the degree of exophthalmos. The examination method varies depending on the suspected causative disease, and thyroid function tests are important for Graves' disease. Imaging diagnostics such as ultrasound, CT, and MRI are essential.

Treatment methods

Treatment methods vary depending on the underlying disease. For Graves' disease, medical treatment for the thyroid gland is the main treatment, while for orbital tumors, open surgical treatment (such as surgery) is performed.

In cases of Graves' disease where the exophthalmos becomes extremely pronounced and affects visual function, surgical procedures such as scraping the orbital bone may be required. Orbital decompression ( Strong and weak ) Antibiotics are used in cases of orbital cellulitis or trauma.

What to do if you notice an illness

If you are diagnosed with Graves' disease at an ophthalmology clinic, you will receive thyroid treatment at an internal medicine clinic. If you experience double vision due to Graves' disease, you should wait until your condition has stabilized before undergoing thyroid treatment. Strabismus ( squint ) I am considering surgery.

In the case of orbital tumors, if the patient's age or imaging diagnosis suggests that the tumor may be malignant, it is best to undergo surgery or other treatment as soon as possible.

Katsunori Ohnishi

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　眼が飛び出しているように見える状態をいいます。原因として多くの病気があり、そのひとつの症状です。

　近視が強い人は眼球の直径が大きくなるので、眼が飛び出したように見えることがありますが、これは眼球突出とはいいません。

原因は何か

　眼球は極めて重要な器官なので、周囲を7つの骨でしっかりと保護されています。この骨で取り囲まれたスペースを眼窩(がんか)といいますが、この眼窩のなかにいろいろなものができたりすると、周囲の硬い骨のほうには広がることができないので眼球を前方へ押しやり、眼球が突出した状態になります。

　眼球突出を起こす原因は多種多様です。両眼が突出する代表的な病気は甲状腺眼症(こうじょうせんがんしょう)で、バセドウ病ともいわれています。また、眼球を動かす外眼筋の炎症の時も、両眼性に眼球突出することがあります。先天性の骨の異常で両眼性の眼球突出があることもあります。

　片眼性の眼球突出としては、眼窩蜂巣炎(がんかほうそうえん)や眼窩腫瘍(がんかしゅよう)が代表的なものです。外傷によっても眼球突出になります。

症状の現れ方

　バセドウ病や眼窩腫瘍の場合は徐々に突出しますが、本人が急に気づくこともあります。眼窩蜂巣炎や外傷の場合は、急性に眼球が突出します。

　眼球突出の方向も、病変の部位と関係があります。バセドウ病の場合は前方に突出しますが、涙腺腫瘍(るいせんしゅよう)では眼球は内下方に突出します。また、視力が低下したり、眼が動きにくくなったり、痛みを伴うこともあります。

検査と診断

　眼球突出の程度を測定するには、ヘルテル眼球突出計を用いて突出度を記録します。予想される原因疾患によって検査法も異なり、バセドウ病では甲状腺機能検査が重要です。超音波、CT、MRIなどの画像診断は必須のものです。

治療の方法

　原疾患により治療法は異なります。バセドウ病では甲状腺に対する内科的な治療が主となりますし、眼窩腫瘍では観血的な外科治療（手術など）を行います。

　バセドウ病でも眼球突出が極めて顕著になり、視機能に影響が出る場合は、眼窩の骨を削るなど観血的に眼窩減圧術(がんかげんあつじゅつ)を行うこともあります。眼窩蜂巣炎や外傷などでは抗生剤を使用します。

病気に気づいたらどうする

　眼科でバセドウ病と診断されたら、内科で甲状腺の治療を受けます。バセドウ病で物が二重に見える（複視）ようになったら、病状が落ちついてから斜視(しゃし)の手術を考えます。

　眼窩腫瘍の場合は、年齢や画像診断で悪性のものが疑われる時は、早急に手術などの治療を受けるほうがよいでしょう。

大西　克尚

出典　法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について　情報

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