Exophthalmos: A Forgotten Clinical Sign of Cushing's Syndrome

Abstract

Exophthalmos is typically associated with Graves' ophthalmopathy. Although originally described by Harvey Cushing, exophthalmos is an underappreciated sign of Cushing's syndrome. We present a case of a 38-year-old female who presented with severe bilateral proptosis and was subsequently diagnosed with Cushings disease. We discuss the possible mechanisms causing exophthalmos in patients with either endogenous or exogenous hypercortisolemia.

A review on ocular findings in mouse lemurs: potential links to age and genetic background

“…It is a visual cloudiness in the lens (Gelatt et al, 2012;Maggs et al, 2012), which is caused by changes in cellular proteins and arrangement, which lead to light-scattering structures. Besides age, UV light and genetic background, as well as oxidative stress, are discussed as major drivers of cataract formation (Sweeney and Truscott, 1998;Moffat et al, 1999;Truscott, 2005;Abdelkader et al, 2015).…”

“…Nuclear sclerosis (NS) is a physiological cloudiness of the lens (Glover and Constantinescu, 1997;Gelatt et al, 2012;Maggs et al, 2012) and must be distinguished from cataracts. Nuclear sclerosis represents a physiological process of the aging lens and is caused by an increased density of lens fibres in the lens core (Gwin and Gelatt, 1981;Glover and Constantinescu, 1997;Keil and Davidson, 2001;Gelatt et al, 2012;Maggs et al, 2012).…”

“…Nuclear sclerosis represents a physiological process of the aging lens and is caused by an increased density of lens fibres in the lens core (Gwin and Gelatt, 1981;Glover and Constantinescu, 1997;Keil and Davidson, 2001;Gelatt et al, 2012;Maggs et al, 2012). It has an influence on the formation of presbyopia by restricting the lens-focusing ability (Glover and Constantinescu, 1997;Gelatt et al, 2012;Maggs et al, 2012). Polygenetic and environmental factors are discussed as possible reasons for NS formation in humans (Klein et al, 2005a).…”

“…Usually no medical treatment is conducted, since nuclear sclerosis alone has not been found to cause major damage to eye structures. Nevertheless, advanced stages with high density impair visual performance and the only known treatment is surgical lens extraction (Glover and Constantinescu, 1997;Wilkie and Colitz, 2009;Gelatt et al, 2012).…”

“…Beltran et al (2007) reported that NS does not represent the first visible cloudiness, without mentioning case numbers (Beltran et al, 2007). Frequent incidences of NS can also be seen in humans (Klein et al, 1992;Klein, 1993;Leske et al, 2002) and other mammals like dogs (Gelatt et al, 2012;Maggs et al, 2012). However, both studies were performed on colonies which originated from different ancestors in Madagascar.…”