Eyeball placed relatively far forward in the skull, resulting in a protruding eye. The condition can be unilateral or bilateral, and may be caused in various ways, commonly by inflammation in the region of the eye, usually sinusitis, a tooth abscess or facial boil. The tissue around the eye swells as a result of the inflammation and forces the eyeball outwards. The eyelids are often swollen, preventing the eye from opening. Treatment is by controlling the inflammation, sometimes by lancing the abscess. Possible complications are encephalitis or inflammation of the cerebral blood vessels. Exophthalmos without inflammation can be caused by hormonal abnormalities. The condition is then usually associated with reduced blinking and drawing back of the upper eyelid, making it more difficult to close the eye. The usual cause is hyperthyroidism. Sometimes this form of exophthalmos is associated with accelerated heartbeat and an enlarged thyroid (Grave’s disease). In 90 per cent of cases the abnormality is then bilateral. The condition can be diagnosed at a glance; if there is no inflammation a specialist should establish whether the cause lies in the thyroid or elsewhere, after which appropriate treatment can be prescribed.

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