Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the

eye An eye is a sensory organ that allows an organism to perceive visual information. It detects light and converts it into electro-chemical impulses in neurons (neurones). It is part of an organism's visual system. In higher organisms, the ey ...

anteriorly out of the

orbit In celestial mechanics, an orbit (also known as orbital revolution) is the curved trajectory of an object such as the trajectory of a planet around a star, or of a natural satellite around a planet, or of an artificial satellite around an ...

. Exophthalmos can be either bilateral (as is often seen in

Graves' disease Graves' disease, also known as toxic diffuse goiter or Basedow's disease, is an autoimmune disease that affects the thyroid. It frequently results in and is the most common cause of hyperthyroidism. It also often results in an enlarged thyro ...

) or unilateral (as is often seen in an orbital tumor). Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma. Exophthalmos has endocrine causes. In the case of Graves' disease, the displacement of the eye results from abnormal connective tissue deposition in the orbit and

extraocular muscles The extraocular muscles, or extrinsic ocular muscles, are the seven extrinsic muscles of the eye in human eye, humans and other animals. Six of the extraocular muscles, the four recti muscles, and the superior oblique muscle, superior and inferior ...

, which can be visualized by CT or

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...

. If left untreated, exophthalmos can cause the eyelids to fail to close during sleep, leading to

cornea The cornea is the transparency (optics), transparent front part of the eyeball which covers the Iris (anatomy), iris, pupil, and Anterior chamber of eyeball, anterior chamber. Along with the anterior chamber and Lens (anatomy), lens, the cornea ...

l dryness and damage. Another possible complication is a form of redness or irritation called

superior limbic keratoconjunctivitis Superior limbic keratoconjunctivitis (SLK, Théodore's syndrome) is a disease of the eye characterized by episodes of recurrent inflammation of the superior cornea and limbus, as well as of the superior tarsal and bulbar conjunctiva. It was first d ...

, in which the area above the cornea becomes inflamed as a result of increased friction when blinking. The process that is causing the displacement of the eye may also compress the

optic nerve In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual system, visual information from the retina to the brain. In humans, the optic nerve i ...

ophthalmic artery The ophthalmic artery (OA) is an artery of the head. It is the first branch of the internal carotid artery distal to the cavernous sinus. Branches of the ophthalmic artery supply all the structures in the orbit around the eye, as well as some ...

, and lead to

blindness Visual or vision impairment (VI or VIP) is the partial or total inability of visual perception. In the absence of treatment such as corrective eyewear, assistive devices, and medical treatment, visual impairment may cause the individual difficul ...

Causes

Many patients with exophthalmos have a history of endocrine abnormalities, including thyroid related disease or “thyrotoxic activity”. Other endocrine related causes of exophthalmos include infection and “IgG4-related disease”. The most common cause of exophthalmos in adults is eye disease associated with a dysfunctioning thyroid gland. Exophthalmos in children is possible and most likely caused by tumors or cancers like leukemia. In rare cases, exophthalmos can occur in patients with normal thyroid function or underactive thyroid function. The thyroid gland is stimulated by thyroid-stimulating hormone (TSH). The majority of patients with Grave’s disease have antibodies called thyroid-stimulating antibodies, which are immune to the thyroid stimulating hormone. The thyroid stimulating hormone has some receptors in the fat cells around the eyeballs. The immune system attacks the fatty tissues, as well as other tissues around the eyes, causing them to stick out from the sockets. There is something called exophthalmos-producing substance, which competes with thyroid stimulating hormone receptors. The affinity of the exophthalmos-producing substance is strengthened if there is also "ophthalmologic immunoglobulins". Exophthalmos can also happen from something that pushes the eye toward the front of the socket. Some examples include blood clots, tumors, infection, or trauma.. According to the

NCBI The National Center for Biotechnology Information (NCBI) is part of the National Library of Medicine (NLM), a branch of the National Institutes of Health (NIH). It is approved and funded by the government of the United States. The NCBI is loca ...

, the following conditions feature exophthalmos: * 4p partial monosomy syndrome Casazza 1

* Acrocephalosyndactyly type I *

Acrofrontofacionasal dysostosis Acrofrontofacionasal dysostosis is an extremely rare disorder, characterized by intellectual disability, short stature, hypertelorism, broad notched nasal tip, cleft lip/palate, postaxial camptobrachypolysyndactyly, fibular hypoplasia, and anomali ...

type 2 * Aneurysm-osteoarthritis syndrome * Antley-Bixler syndrome *

Atelosteogenesis type I Atelosteogenesis type I is a rare autosomal dominant condition. This condition is evident at birth and is associated with a very poor prognosis for the baby. It may be diagnosed antenatally. Signs and symptoms Clinical features include * Abnorma ...

Autism spectrum disorder Autism, also known as autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by differences or difficulties in social communication and interaction, a preference for predictability and routine, sensory processing di ...

due to

AUTS2 AUTS2, activator of transcription and developmental regulator is a protein that in humans is encoded by the AUTS2 gene. Function This gene has been implicated in neurodevelopment and as a candidate gene for numerous neurological disorders, i ...

deficiency *

Autosomal dominant intellectual disability-craniofacial anomalies-cardiac defects syndrome Autosomal dominant intellectual disability-craniofacial anomalies-cardiac defects syndrome is a rare genetic disorder which is characterized by multi-systemic symptoms primarily affecting the intellect and post-natal development. Signs and symp ...

Autosomal dominant In genetics, dominance is the phenomenon of one variant (allele) of a gene on a chromosome masking or overriding the Phenotype, effect of a different variant of the same gene on Homologous chromosome, the other copy of the chromosome. The firs ...

Robinow syndrome Robinow syndrome is an extremely rare genetic disorder characterized by short-limbed dwarfism, abnormalities in the head, face, and external sex organ, genitalia, and vertebrae, vertebral segmentation. The disorder was first described in 1969 by h ...

1–3 *

Autosomal recessive In genetics, dominance is the phenomenon of one variant (allele) of a gene on a chromosome masking or overriding the Phenotype, effect of a different variant of the same gene on Homologous chromosome, the other copy of the chromosome. The firs ...

congenital ichthyosis Ichthyosis is a family of genetic skin disorders characterized by dry, thickened, scaly skin. The more than 20 types of ichthyosis range in severity of symptoms, outward appearance, underlying genetic cause and mode of inheritance (e.g., domi ...

4B * Autosomal recessive osteopetrosis 5, 7 * Autosomal recessive Robinow syndrome * Axenfeld-Rieger anomaly with partially absent eye muscles, distinctive face, hydrocephaly, and skeletal abnormalities * Axenfeld-Rieger syndrome type 3 * Beare-Stevenson cutis gyrata syndrome * Beckwith-Wiedemann syndrome * Bohring-Opitz syndrome * Cardio-facio-cutaneous syndrome * Catel-Manzke syndrome * Childhood

hypophosphatasia Hypophosphatasia (; also called deficiency of alkaline phosphatase, phosphoethanolaminuria, or Rathbun's syndrome; sometimes abbreviated HPP) is a rare, and sometimes fatal, inherited metabolic bone disease. Clinical symptoms are heterogeneous ...

Chondrodysplasia An osteochondrodysplasia,Etymology: . or skeletal dysplasia, is a disorder of the development of bone and cartilage. Osteochondrodysplasias are rare diseases. About 1 in 5,000 babies are born with some type of skeletal dysplasia. Nonetheless, if t ...

with joint dislocations, gPAPP type Davis Oxycephalus 1

* Cloverleaf skull syndrome *

COG1 Conserved oligomeric Golgi complex subunit 1 is a protein that in humans is encoded by the ''COG1'' gene In biology, the word gene has two meanings. The Mendelian gene is a basic unit of heredity. The molecular gene is a sequence of nucleot ...

congenital disorder of glycosylation A congenital disorder of glycosylation (previously called carbohydrate-deficient glycoprotein syndrome) is one of several rare inborn errors of metabolism in which glycosylation of a variety of tissue proteins and/or lipids is deficient or defect ...

* Cole-Carpenter syndrome 1, 2 *

Congenital myopathy Congenital myopathy is a very broad term for any muscle disorder present at birth. This defect primarily affects skeletal muscle fibres and causes muscular weakness and/or hypotonia. Congenital myopathies account for one of the top neuromuscular di ...

22A, classic * Congenital myopathy 22B, severe fetal *

Cornelia de Lange syndrome Cornelia de Lange syndrome (CdLS) is a genetic disorder. People with Cornelia de Lange syndrome experience a range of physical, cognitive, and medical challenges ranging from mild to severe. Cornelia de Lange syndrome has a widely varied phenotype, ...

1 *

Craniosynostosis Craniosynostosis is a condition in which one or more of the fibrous sutures in a young infant's skull prematurely fuses by turning into bone (ossification), thereby changing the growth pattern of the skull. Because the skull cannot expand perpe ...

4 *

Craniosynostosis and dental anomalies Craniosynostosis and dental anomalies (CRSDA, also known as Kreiborg-Pakistani syndrome) is an autosomal recessive syndrome characterized by craniosynostosis, maxillary hypoplasia, and dental anomalies. Dental anomalies seen in this condition inclu ...

Crouzon syndrome Crouzon syndrome is an autosomal dominant genetic disorder known as a branchial arch syndrome. Specifically, this syndrome affects the first branchial (or pharyngeal) arch, which is the precursor of the maxilla and mandible. Because the branchia ...

* Crouzon syndrome-acanthosis nigricans syndrome *

Cutis laxa Cutis laxa or pachydermatocele is a group of rare connective tissue disorders in which the skin becomes inelastic and hangs loosely in folds. Signs and symptoms It is characterised by skin that is loose, hanging, wrinkled, and lacking in elasti ...

, autosomal recessive, types 1B and 2E * Developmental and

epileptic Epilepsy is a group of non-communicable neurological disorders characterized by a tendency for recurrent, unprovoked seizures. A seizure is a sudden burst of abnormal electrical activity in the brain that can cause a variety of symptoms, rang ...

encephalopathy Encephalopathy (; ) means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of overall brain dysfunction; this syndrome ...

, 48, 75, and 80 * Donnai-Barrow syndrome * Ehlers-Danlos syndrome, spondylodysplastic type, 1 and 2 * Familial

hyperthyroidism Hyperthyroidism is a endocrine disease in which the thyroid gland produces excessive amounts of thyroid hormones. Thyrotoxicosis is a condition that occurs due to elevated levels of thyroid hormones of any cause and therefore includes hyperth ...

due to mutations in TSH receptor *

Fibrochondrogenesis Fibrochondrogenesis is a rare autosomal recessive form of osteochondrodysplasia, causing abnormal fibrous development of cartilage and related tissues. It is a lethal rhizomelic (malformations which result in short, underdeveloped limbs) form o ...

1 *

Fibrous dysplasia Fibrous dysplasia is a very rare nonhereditary genetic disorder where normal bone and marrow is replaced with fibrous tissue, resulting in formation of bone that is weak and prone to expansion. As a result, most complications result from fract ...

of jaw *

Filippi syndrome Filippi syndrome, also known as Syndactyly Type I with Microcephaly and Mental Retardation, is a very rare autosomal recessive genetic disease. Only a very limited number of cases have been reported to date. Filippi Syndrome is associated with dive ...

* Fontaine progeroid syndrome * Frank-Ter Haar syndrome *

Graves disease Graves' disease, also known as toxic diffuse goiter or Basedow's disease, is an autoimmune disease that affects the thyroid. It frequently results in and is the most common cause of hyperthyroidism. It also often results in an enlarged thyroid. ...

, susceptibility to, 1 * H syndrome *

Holoprosencephaly Holoprosencephaly (HPE) is a cephalic disorder in which the prosencephalon (the forebrain of the embryo) fails to Prenatal development, develop into two Cerebral hemisphere, hemispheres, typically occurring between the 18th and 28th day of gestati ...

2, 3, and 11 * Intellectual disability, X-linked, syndromic 33 * Jackson-Weiss syndrome * Keppen-Lubinsky syndrome *

Kniest dysplasia Kniest dysplasia is a rare form of dwarfism caused by a mutation in the '' COL2A1'' gene on chromosome 12. The ''COL2A1'' gene is responsible for producing type II collagen. The mutation of the ''COL2A1'' gene leads to abnormal skeletal growth an ...

* Larsen-like syndrome,

B3GAT3 Beta-1,3-Glucuronyltransferase 3 is an enzyme that in humans is encoded by the ''B3GAT3'' gene In biology, the word gene has two meanings. The Mendelian gene is a basic unit of heredity. The molecular gene is a sequence of nucleotides in DN ...

type * Leprechaunism syndrome *

Liver disease Liver disease, or hepatic disease, is any of many diseases of the liver. If long-lasting it is termed chronic liver disease. Although the diseases differ in detail, liver diseases often have features in common. Liver diseases File:Ground gla ...

, severe congenital * Loeys-Dietz syndrome 1, 2 *

Mandibuloacral dysplasia Mandibuloacral dysplasia (MAD) is a rare autosomal recessive syndrome characterized by mandibular hypoplasia, delayed cranial suture closure, dysplastic clavicles, abbreviated and club-shaped terminal phalanges, acroosteolysis, atrophy of the ski ...

progeroid syndrome * Mandibuloacral dysplasia with type A

lipodystrophy Lipodystrophy syndromes are a group of genetic or acquired disorders in which the body is unable to produce and maintain healthy fat tissue. The medical condition is characterized by abnormal or degenerative conditions of the body's adipose tissu ...

* Mandibuloacral dysplasia with type B lipodystrophy * Marbach-Rustad progeroid syndrome * Marshall-Smith syndrome * Melnick-Needles syndrome * Microcephalic osteodysplastic primordial dwarfism, type 3 *

Microcephaly Microcephaly (from Neo-Latin ''microcephalia'', from Ancient Greek μικρός ''mikrós'' "small" and κεφαλή ''kephalé'' "head") is a medical condition involving a smaller-than-normal head. Microcephaly may be present at birth or it m ...

3, primary, autosomal recessive * Microcephaly 5, primary, autosomal recessive *

Muenke syndrome Muenke syndrome, also known as FGFR3-related craniosynostosis, is a human specific condition characterized by the premature closure of certain bones of the skull during development, which affects the shape of the head and face. First described by M ...

NDE1 Nuclear distribution protein nudE homolog 1 is a protein that in humans is encoded by the ''NDE1'' gene. Clinical significance Mutations In biology, a mutation is an alteration in the nucleic acid sequence of the genome of an organism, ...

-related

microhydranencephaly Microhydranencephaly (MHAC) is a severe abnormality of brain development characterized by both microcephaly and hydranencephaly. Signs and symptoms may include severe microcephaly, scalp rugae (a series of ridges), and profound intellectual disabil ...

* Neonatal pseudo-hydrocephalic progeroid syndrome * Nestor-Guillermo progeria syndrome * Neu-Laxova syndrome 1, 2 *

Ogden syndrome Ogden syndrome, also known as N-terminal N-acetyltransferase, acetyltransferase deficiency (NATD), is an X-linked disorder of infancy comprising a distinct combination of distinctive craniofacial features producing an aged appearance, growth failu ...

Osteogenesis imperfecta Osteogenesis imperfecta (; OI), colloquially known as brittle bone disease, is a group of genetic disorders that all result in bones that bone fracture, break easily. The range of symptoms—on the skeleton as well as on the body's other Or ...

types 7, 8 * Pallister-Killian syndrome *

Periventricular nodular heterotopia MRI of a child experiencing seizures. There are small foci of grey matter heterotopia in the corpus callosum, deep to the Cortical dysplasia">dysplastic cortex. (double arrows)">Heterotopia (medicine)">heterotopia in the corpus callosum, deep ...

7 *

Pontocerebellar hypoplasia Pontocerebellar hypoplasia (PCH) is a heterogeneous group of rare neurodegenerative disorders caused by genetic mutations and characterised by progressive atrophy of various parts of the brain such as the cerebellum or brainstem (particularly th ...

types 3, 10 * Progeroid and marfanoid aspect-lipodystrophy syndrome * Prolidase deficiency *

Restrictive dermopathy Restrictive dermopathy (RD) is a rare, lethal autosomal recessive skin condition characterized by syndromic facies, tight skin, sparse or absent eyelashes, and secondary joint changes.James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' ...

2 * Rienhoff syndrome *

Ritscher-Schinzel syndrome 3C syndrome is a rare condition whose symptoms include heart defects, cerebellar hypoplasia, and cranial dysmorphism. It was first described in the medical literature in 1987 by Ritscher and Schinzel, for whom the disorder is sometimes named. Si ...

4 * Roberts-SC phocomelia syndrome * Robinow syndrome, autosomal recessive 2 * Rubinstein-Taybi syndrome due to

CREBBP CREB-binding protein, also known as CREBBP or CBP or KAT3A, (where CREB is cAMP response element-binding protein) is a coactivator encoded by the ''CREBBP'' gene in humans, located on chromosome 16p13.3. CBP has intrinsic acetyltransferase funct ...

mutations *

Sclerosteosis Sclerosteosis is an autosomal recessive disorder characterized by bone overgrowth. It was first described in 1958 but given the current name in 1967. Excessive bone formation is most prominent in the skull, mandible and tubular bones. It can cause ...

1 * Shprintzen-Goldberg syndrome * Spondyloepimetaphyseal dysplasia with joint laxity, type 1, with or without fractures *

Spondyloepimetaphyseal dysplasia-short limb-abnormal calcification syndrome Spondyloepimetaphyseal dysplasia-short limb-abnormal calcification syndrome is a rare genetic disorder which is characterized by osseous anomalies resulting in short stature and other afflictions. Signs and symptoms It consists of the followin ...

* Spondylometaphyseal dysplasia with

corneal dystrophy Corneal dystrophy is a group of rare hereditary disorders characterised by bilateral abnormal deposition of substances in the transparent front part of the eye called the cornea. Signs and symptoms Corneal dystrophy may not significantly affect ...

Tetralogy of Fallot Tetralogy of Fallot (TOF), formerly known as Steno-Fallot tetralogy, is a congenital heart defect characterized by four specific cardiac defects. Classically, the four defects are: * Pulmonary stenosis, which is narrowing of the exit from the r ...

Thyroid hormone resistance Thyroid hormone resistance (also resistance to thyroid hormone (RTH), and sometimes Refetoff syndrome) describes a rare syndrome in which the thyroid hormone levels are elevated but the thyroid stimulating hormone (TSH) level is not suppressed, or ...

, generalized, autosomal recessive * Yunis-Varon syndrome

Anatomy

Proptosis is the anterior displacement of the eye from the orbit. Since the orbit is closed off posteriorly, medially and laterally, any enlargement of structures located within will cause the anterior displacement of the eye. Swelling or enlargement of the lacrimal gland causes inferior medial and anterior dislocation of the eye. This is because the lacrimal glands are located superiorly and laterally in the orbit.

Diagnosis and treatment

Measurement

Measurement of the degree of exophthalmos is performed using an exophthalmometer. Most sources define exophthalmos/proptosis as a protrusion of the globe greater than 18 mm. The term exophthalmos is often used when describing proptosis associated with

Treatment

Exophthalmos is a progressive disease, so early detection and treatment is ideal. Diagnosing this condition may include imaging scans such as CT or MRI as well as blood tests to determine if the thyroid gland is functioning properly. Often, eye protrusion is measured to see how the disease progresses.Treatment for this disease includes radiation, surgery, and quitting smoking. Many times exophthalmos symptoms improve when hyperthyroidism is controlled, possibly using corticosteroid hormone replacement therapy.

Animals

Exophthalmos is commonly found in

dog The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the gray wolf. Also called the domestic dog, it was selectively bred from a population of wolves during the Late Pleistocene by hunter-gatherers. ...

s. It is seen in

brachycephalic Brachycephaly (derived from the Ancient Greek '' βραχύς'', 'short' and '' κεφαλή'', 'head') is the shape of a skull shorter than average in its species. It is perceived as a cosmetically desirable trait in some domesticated dog and ...

(short-nosed) dog breeds because of the shallow

. It can lead to

keratitis Keratitis is a condition in which the human eye, eye's cornea, the clear dome on the front surface of the eye, becomes inflammation, inflamed. The condition is often marked by moderate to intense pain and usually involves any of the following sy ...

secondary to exposure of the

. Exophthalmos is commonly seen in the

pug The Pug is a breed of dog with the physically distinctive features of a wrinkly, short-muzzled face, and curled tail. An ancient breed, with roots dating back to 400 B.C., they have a fine, glossy coat that comes in a variety of colors, most ...

Boston terrier The Boston Terrier is a breed of dog originating in the United States of America. This "American Gentleman" was accepted in 1893 by the American Kennel Club as a non-sporting breed. Boston Terriers are small and compact with a short tail and ere ...

Pekingese The Pekingese (also spelled Pekinese) is a dog breed, breed of toy dog, originating in China. The breed was favored by royalty of the Chinese sovereign, Chinese Imperial court as a companion dog, and its name refers to the city of Beijing (Peki ...

, and shih tzu. It is a common result of

head trauma A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of inj ...

and pressure exerted on the front of the neck too hard in dogs. In cats, eye proptosis is uncommon and is often accompanied by facial fractures. About 40% of proptosed eyes retain vision after being replaced in the

, but in cats very few retain vision. Replacement of the eye requires general

anesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...

. The eyelids are pulled outward, and the eye is gently pushed back into place. The eyelids are sewn together in a procedure known as

tarsorrhaphy Tarsorrhaphy is a surgical procedure in which the eyelids are partially sewn together to narrow the eyelid opening. It may be done to protect the cornea in cases of corneal exposure, as a treatment for Graves' ophthalmopathy, Möbius syndrome or ...

for about five days to keep the eye in place. Replaced eyes have a higher rate of

keratoconjunctivitis sicca Dry eye syndrome, also known as keratoconjunctivitis sicca, is the condition of having dry eyes. Symptoms include dryness in the eye, irritation, redness, discharge, blurred vision, and easily fatigued eyes. Symptoms range from mild and occas ...

and

and often require lifelong treatment. If the damage is severe, the eye is removed in a relatively simple

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

known as

enucleation of the eye Enucleation is the removal of the eye that leaves the eye muscles and remaining orbital contents intact. This type of ocular surgery is indicated for a number of ocular tumors, in eyes that have sustained severe trauma, and in eyes that are oth ...

. The

prognosis Prognosis ( Greek: πρόγνωσις "fore-knowing, foreseeing"; : prognoses) is a medical term for predicting the likelihood or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) ...

for a replaced eye is determined by the extent of damage to the

and

sclera The sclera, also known as the white of the eye or, in older literature, as the tunica albuginea oculi, is the opaque, fibrous, protective outer layer of the eye containing mainly collagen and some crucial elastic fiber. In the development of t ...

, the presence or absence of a

pupillary light reflex The pupillary light reflex (PLR) or photopupillary reflex is a reflex that controls the diameter of the pupil, in response to the intensity ( luminance) of light that falls on the retinal ganglion cells of the retina in the back of the eye, t ...

, and the presence of ruptured

rectus muscle Rectus muscle (Latin: , "straight muscle") may refer to: In the trunk: * Rectus abdominis muscle In the eye: * Inferior rectus muscle * Lateral rectus muscle * Medial rectus muscle * Superior rectus muscle In the leg: * Rectus femoris muscle In ...

s. The rectus muscles normally help hold the eye in place and direct eye movement. Rupture of more than two rectus muscles usually requires the eye to be removed, because significant blood vessel and nerve damage also usually occurs. Compared to brachycephalic breeds, dochilocephalic (long-nosed) breeds usually have more trauma to the eye and its surrounding structures, so the prognosis is worse.

References

{{Authority control Disorders of eyelid, lacrimal system and orbit Dog diseases