Open Access Open Access  Restricted Access Subscription Access

Understanding Drugs Acting on Proptosis in Humans: Mechanisms and Therapeutic Approaches

Ramanjaneyulu D. V., Sravani Pragna K., Muralinath E., Kalyan C. Chakravarthi, Sony Sharlet E., Sai Hemachand N., Manjari P., Sravani K., Guru Prasad M., Sai Kumar M., Poojitha P., Bharat M., Gnana Lahari R.

Abstract


       Proptosis is also termed as exophthalmos.  It refers to the abnormal  protrusion  of eyeball from the orbit.  This condition occurs because of Various inheriting causes, including g thyroid eye disease ( TED ), orbital tumors, inflammation  and trauma  Corticosteroids are frequently used for treating an inflammatory conditions  regarding proptosis, particularly in cases of TED.  Anti_thyroid drugs namely propyl thio uracil and methimazole regulate thryroid  function  and can assist in regulating the progression of associated ocular misalingment, along with proptosis. Prism glasses may also be prescribed to enhance binocular vision and reduce diplopia resulting from ocular misalignment.  Exophthalmos is the protrusion of one or both eyes anteriorly out of the orbit because  of an enhancement  in orbital contents within the rigid bony orbit. It most commonly manifests in thyroid-associated eye disease  namely  Graves' disease ophthalmopathy. Clinicians need to be aware of the differential diagnoses that may also lead to  exophthalmos, as these could be easily missed in patients  along with deranged thyroid function. To restore and maintain optimum vision, it must be diagnosed and treated in a prompt  manner. The assessment and treatment of exophthalmos are illustrated in this activity, which also emphasizes the importance of the interprofessional team in the patient's care. Ultimately, the management of proptosis in humans requires a multimodal strategy that not only treats the underlying cause of the condition but also relieves its symptoms.


Full Text:

PDF

References


Aronson JK, Ramachandran M. The diagnosis of art: exophthalmos--Gustave Doré's ogre. J R Soc Med. 2006 Aug;99(8):421. [PMC free article] [PubMed]

Baujat B, Krastinova D, Bach CA, Coquille F, Chabolle F. Orbital morphology in exophthalmos and exorbitism. Plast Reconstr Surg. 2006 Feb;117(2):542-50; discussion 551-2. [PubMed]

René C. Update on orbital anatomy. Eye (Lond). 2006 Oct;20(10):1119-29. [PubMed]

Lefebvre DR, Reinshagen KL, Yoon MK, Stone JH, Stagner AM. Case 39-2018: An 18-Year-Old Man with Diplopia and Proptosis of the Left Eye. N Engl J Med. 2018 Dec 20;379(25):2452-2461. [PubMed]

Smith C, Hameed S, Rose GE, Wernig F. A 61 year old man with pancreatitis, pituitary dysfunction, and painful exophthalmos. BMJ. 2019 Feb 21;364:l93. [PubMed]

Goto S, Takeda H, Sasahara Y, Takanashi I, Yamashita H. Metastasis of advanced gastric cancer to the extraocular muscle: a case report. J Med Case Rep. 2019 Apr 26;13(1):107. [PMC free article] [PubMed]

Rakul Nambiar K, Ajith PS, Arjunan A. Unilateral proptosis as the initial manifestation of malignancy. J Egypt Natl Canc Inst. 2017 Sep;29(3):159-161. [PubMed]

Topilow NJ, Tran AQ, Koo EB, Alabiad CR. Etiologies of Proptosis: A review. Intern Med Rev (Wash D C). 2020 Mar;6(3) [PMC free article] [PubMed]

Kamawal A, Schmidt MA, Rompel O, Gusek-Schneider GC, Mardin CY, Trollmann R. [Cavernous sinus thrombosis as a rare cause of exophthalmos in childhood : A case report]. Ophthalmologe. 2017 May;114(5):457-461. [PubMed]

Lanier VC. The surgical treatment of exophthalmos. A review. Plast Reconstr Surg. 1975 Jan;55(1):56-64. [PubMed]

Garrity JA, Bahn RS. Pathogenesis of graves ophthalmopathy: implications for prediction, prevention, and treatment. Am J Ophthalmol. 2006 Jul;142(1):147-153. [PMC free article] [PubMed]

IRVINE AR. Exophthalmos from the standpoint of the ophthalmologist. Calif Med. 1954 Feb;80(2):75-7. [PMC free article] [PubMed]

Danishyar A, Sergent SR. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Orbital Cellulitis. [PubMed]

Howells MS, Sharma R. Orbital varices. BMJ Case Rep. 2019 Dec 08;12(12) [PMC free article] [PubMed]

Klingenstein A, Hintschich C. [Diagnostic Management of Exophthalmos]. Klin Monbl Augenheilkd. 2017 Jan;234(1):53-58. [PubMed]

Patel BC. In Praise of Precision: Esoglobus and Exoglobus. Ophthalmic Plast Reconstr Surg. 2017 Jan/Feb;33(1):72-73. [PubMed]

Bhatti MT, Dutton JJ. Thyroid eye disease: therapy in the active phase. J Neuroophthalmol. 2014 Jun;34(2):186-97. [PubMed]

Bartalena L. Prevention of Graves' ophthalmopathy. Best Pract Res Clin Endocrinol Metab. 2012 Jun;26(3):371-9. [PubMed]

Verity DH, Rose GE. Acute thyroid eye disease (TED): principles of medical and surgical management. Eye (Lond). 2013 Mar;27(3):308-19. [PMC free article] [PubMed]

Marcocci C, Marinò M. Treatment of mild, moderate-to-severe and very severe Graves' orbitopathy. Best Pract Res Clin Endocrinol Metab. 2012 Jun;26(3):325-37. [PubMed]

Rootman J Diseases of the Orbit: A Multidisciplinary Approach. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2003. [Google Scholar]

Dutton JJ. Atlas of Clinical and Surgical Orbital Anatomy. 2nd ed. Philadelphia: Elsevier Saunders; 2011. [Google Scholar]

Aviv RI, Casselman J. Orbital imaging: Part 1. Normal anatomy Clin Radiol. 2005. March;60(3):279–87. [PubMed] [Google Scholar]

Conneely MF, Hacein-Bey L, Jay WM. Magnetic resonance imaging of the orbit. Semin Ophthalmol. 2008. May-Jun;23(3): 179–89. [PubMed] [Google Scholar]

Hallman JT, Pillay P, Koh LH, Goh KY, Yu WY. Eye Globe Abnormalities on MR and CT in adults: An Anatomical Approach. Korean J Radiol. 2016. Sep-Oct; 17(5): 664–673. [PMC free article] [PubMed] [Google Scholar]

Aviv RI1, Miszkiel K. Orbital imaging: Part 2. Intraorbital pathology. Clin Radiol. 2005. March;60(3):288–307. [PubMed] [Google Scholar]

Rootman J1, Heran MK, Graeb DA. Vascular malformations of the orbit: classification and the role of imaging in diagnosis and treatment strategies. Ophthalmic Plast Reconstr Surg. 2014. Mar-Apr;30(2):91–104. [PubMed] [Google Scholar]

Fledelius HC. Ultrasound in ophthalmology. Ultrasound Med Biol. 1997;23(3):365–75. [PubMed] [Google Scholar]

Yan L, He G, Zhou X, Zheng Y, Zhu Y, Yang J, Zhang M, Zhou Y. Clin Radiol. 2017. September;72(9):798 Contrast-enhanced ultrasound in the diagnosis of orbital space-occupying lesions. [PubMed] [Google Scholar]

Ekhlassi T, Becker N. Preseptal and orbital cellulitis. Dis Mon. 2017. February;63(2):30–32. [PubMed] [Google Scholar]

Tsirouki T, Dastiridou AI, Ibanez Flores N, Cerpa JC, Moschos MM, Brazitikos P, Androudi S. Orbital cellulitis. Surv Ophthalmol. 2018. Jul-Aug;63(4):534–553. [PubMed] [Google Scholar]

Danishyar A, Sergent SR. Orbital Cellulitis. StatPearls Publishing. 2019. [PubMed] [Google Scholar]

Yohai RA, Bullock JD, Aziz AA, Markert RJ. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol. 1994. Jul-Aug;39(l):3–22. [PubMed] [Google Scholar]

Bl Spellberg, Walsh TJ, Kontoyiannis DP, Edwards J Jr, Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis. 2009. 0;48(12): 1743–51. [PMC free article] [PubMed] [Google Scholar]

Greenberg RN, Mullane K, van Burik JA, Raad I, Abzug MJ, Anstead G, Herbrecht R, Fangston A, Marr KA, Schiller G, Schuster M, Wingard JR, Gonzalez CE, Revankar SG, Corcoran G, Kryscio RJ, Hare R. Posaconazole as salvage therapy for zygomycosis. Antimicrob Agents Chemother. 2006. January;50(l): 126–33. [PMC free article] [PubMed] [Google Scholar]

Nithyanandam S, Jacob MS, Battu RR, Thomas RK, Correa MA, D’Souza O. Rhino-orbito-cerebral mucormycosis. A retrospective analysis of clinical features and treatment outcomes. Indian J Ophthalmol. 2003. September;51(3):231–6. [PubMed] [Google Scholar]

Hirabayashi KE, Kalin-Hajdu E, Brodie FL, Kersten RC, Russell MS, Vagefi MR. Retrobulbar Injection of Amphotericin B for Orbital Mucormycosis. Ophthalmic Plast Reconstr Surg. 2017. Jul-Aug;33(4):e94–e97. [PubMed] [Google Scholar]

Har-El G Endoscopic management of 108 sinus mucoceles. Laryngoscope. 2001. December;lll(12):2131–4. [PubMed] [Google Scholar]

Capra GG, Carbone PN, Mullin DP. Paranasal Sinus Mucocele. Head Neck Pathol. 2012. September; 6(3): 369–372. [PMC free article] [PubMed] [Google Scholar]

Devars du Mayne M, Moya-Plana A, Malinvaud D, Laccourreye O, Bonfds P. Sinus mucocele: natural history and long-term recurrence rate. Eur Ann Otorhinolaryngol Head Neck Dis. 2012. June; 129(3): 125–30. [PubMed] [Google Scholar]

Zukin LM, Hink EM, Liao S, Getz AE, Kingdom TT, Ramakrishnan V. Endoscopic Management of Paranasal Sinus Mucoceles: Meta-analysis of Visual Outcomes. Otolaryngol Head Neck Surg. 2017. November;157(5):760–766. [PMC free article] [PubMed] [Google Scholar]

Lloyd G, Lund VJ, Savy L, Howard D. Optimum imaging for mucoceles. J Laryngol Otol. 2000. March;1 14(3):233–6. [PubMed] [Google Scholar]

Capra GG, Carbone PN, Mullin DP. Head and Neck Pathol. 2012. September; 6(3): 369. [PMC free article] [PubMed] [Google Scholar]

Loo JL, Looi AL, Seah LL. Visual outcomes in patients with paranasal mucoceles. Ophthalmic Plast Reconstr Surg. 2009. Mar-Apr;25(2): 126–9. [PubMed] [Google Scholar]

Kim YS, Kim K, Lee JG, Yoon JH, Kim CH. Paranasal sinus mucoceles with ophthalmologic manifestations: a 17-year review of 96 cases. Am J Rhinol Allergy. 2011. Jul-Aug;25(4):272–5 [PubMed] [Google Scholar]

Obeso S, Llorente JL, Rodrigo JP, Sanchez R, Mancebo G, Suarez C. Paranasal sinuses mucoceles. Our experience in 72 patients. Acta Otorrinolaringol Esp. 2009;60(5):332–9. [PubMed] [Google Scholar]

Bartley GB. The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota. Trans Am Ophthalmol Soc. 1994;92:477–588. [PMC free article] [PubMed] [Google Scholar]

Kamminga N, Jansonius NM, Pott JR, Links TP. Unilateral proptosis: the role of medical history. Br J Ophthalmol. 2003. March; 87(3): 370–371. [PMC free article] [PubMed] [Google Scholar]

Weiler DL. Thyroid eye disease: a review. Clin Exp Optom. 2017. January;100(1):20–25. [PubMed] [Google Scholar]

Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves’ ophthalmopathy. ypoer [PubMed] [Google Scholar]

Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, Gorman CA. Clinical features of Graves’ ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996. March;121(3):284–90. [PubMed] [Google Scholar]

Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, Pariani N, Gallo D, Azzolini C, Ferrario M, Bartalena L. Prevalence and natural history of Graves’ orbitopathy in a large series of patients with newly diagnosed graves’ hyperthyroidism seen at a single center. J Clin Endocrinol Metab. 2013. April;98(4)T443–9. [PubMed] [Google Scholar]

Khong JJ, Finch S, De Silva C, Rylander S, Craig JE, Selva D, Ebeling PR. Risk Factors for Graves’ Orbitopathy; the Australian Thyroid-Associated Orbitopathy Research (ATOR) Study. J Clin Endocrinol Metab. 2016. July;101(7):2711–20. [PubMed] [Google Scholar]

Kung AW, Yau CC, Cheng A. The incidence of ophthalmopathy after radioiodine therapy for Graves’ disease: prognostic factors and the role of methimazole. J Clin Endocrinol Metab. 1994. August;79(2):542–6. [PubMed] [Google Scholar]

Li Z, Cestari DM, Fortin E. Thyroid eye disease: what is new to know? Curr Opin Ophthalmol. 2018. November;29(6):528–534. [PubMed] [Google Scholar]


Refbacks

  • There are currently no refbacks.