Bilateral Exophthalmos in Adults
Bilateral exophthalmos occurs more commonly in adults than in children, offers more difficulty in diagnosis, and, as a rule, is not as easy to treat. Blood disturbances such as spontaneous leukemic and traumatic hemorrhages cause some cases, and a rare type of glandular and blood disease known as Mikulicz’s disease, as well as other types of leukemia, may be responsible for other cases. The exophthalmos associated with trichinosis, allergy, and serous tenonitis is mainly due to edema while in hyperthyroidism, malignant exophthalmos, hypothyroidism, and hypertension the proptosis is caused by edema, but the tissue finally becomes fibrotic and solid. Cerebral aneurysms may produce bilateral exophthalmos, as may cavernous sinus thrombosis or lateral sinus thrombosis. Paget’s disease and acromegaly cause deformities in the skull which produce exophthalmos analogous to that seen in tower skull and hydrocephalus in children. However, in neither of these diseases is exophthalmos a prominent or important sign. Exophthalmos may result from muscular relaxation due to external ophthalmoplegia, but this is rare.
The most common cause of bilateral exophthalmos in adults, as well as in children, is disease of the thyroid gland. Hyperthyroidism or toxic goiter is a common, devastating, general disease which seriously affects the eyes and is often injudiciously treated by surgeons and oculists alike.
The conditions that cause hemorrhage producing exophthalmos in children will do the same in adults, and in the latter, arteriosclerosis is responsible for an occasional case of this type. The incidence of exophthalmos from hemorrhage. . .