Exophthalmos

Definition

Exophthalmos (proptosis) is anterior displacement of the eyeball from the orbit. When bilateral and associated with hyperthyroidism, it is termed Graves' ophthalmopathy.

Causes

• Graves' disease (most common)
• Orbital tumor
• Retro-orbital hematoma
• Orbital cellulitis
• Arteriovenous fistula

Associated Symptoms

Lid retraction, diplopia, tearing, photophobia, gritty sensation, optic nerve compression (vision loss in severe cases), corneal drying and ulceration.

Nursing Interventions

Protect the cornea: artificial tears during the day, lubricating ointment at night, sunglasses, and eye patches if necessary. Elevate HOB to reduce periorbital edema. Teach patients with Graves' disease about antithyroid medications (methimazole, propylthiouracil), radioactive iodine, or thyroidectomy. Avoid smoking (worsens ophthalmopathy).

NCLEX Relevance

Classic cue for Graves' disease/hyperthyroidism. Corneal protection is a nursing priority.