Definition

Phthisis bulbi is a severe damage that occurs to the eyeball. This damage is called the “final stage” or end-stage eye of eye damage. Phthisis bulbi can be caused by many things, ranging from extensive eye inflammation to complications from eye surgery. Due to the shrinkage process, the eyeball that experiences phthisis bulbi will be smaller than the normal eyeball. Eyes that experience phthisis bulbi cannot function properly because various changes occur in the structure of the eyeball. This condition is an indication for eye surgery.

Causes

There are several groups of causes for phthisis bulbi, including:

•  Trauma/injury to the eyeball, such as sharp trauma, blunt trauma, and trauma from alkaline chemicals.
•  Infections, such as keratitis, endophthalmitis, panophthalmitis.
•  Retinal detachment, a condition where the retina separates from the eye.
• Post-surgery, such as cataract surgery, glaucoma, cornea, and vitrectomy.
• Long-term inflammation, such as uveitis.
• Vascular abnormalities, such as retinopathy of prematurity (ROP)—a condition of blindness in premature infants caused by excessive oxygen administration during resuscitation; and diabetic retinopathy.
• Congenital or birth defects.
• Tumors, such as retinoblastoma.
• Drugs, such as cidofovir.

All these causes can lead to ocular hypotony or decreased intraocular pressure, damage to eye blood vessels, and continuous inflammation. Decreased intraocular pressure below 5 mmHg can hinder the delivery of nutrients and oxygen needed by the eye, further disrupting the structure of the eyeball. If structural damage is very advanced, phthisis bulbi can occur.

Risk factor

Having diseases related to long-term inflammation in the body can increase the risk of phthisis bulbi, especially due to inflammation in the internal structures of the eye. These diseases include:

•  Psoriasis
• Rheumatoid arthritis
•  Ankylosing spondylitis (arthritis of the spine)
•  Ulcerative colitis
• Herpes
• AIDS
• Kawasaki disease
• Syphilis
•  Tuberculosis
• Retinoblastoma in children, with some reports indicating phthisis bulbi as a presentation of untreated retinoblastoma

If you have these conditions or autoimmune diseases, regularly check your eyes to detect early changes in the eyeball.

Symptoms

Since phthisis bulbi is a gradual condition, symptoms worsen over time. Symptoms include:

• Blurred vision
•  Floaters, seeing black shadows moving across the eye
•  Sensitivity to light
•  Eye pain
•  Red eye
•  Swollen eye
•  Blindness
•  The eye becomes smaller compared to a healthy eye

In phthisis bulbi, the eye will shrink, and the white part of the eye or sclera will thicken.

Diagnosis

Your doctor will ask about your medical history and the progression of your phthisis bulbi. A physical examination will be conducted using ophthalmoscopy or a slit lamp to view the condition of your eyeball in more detail. The doctor may then perform radiological examinations, such as CT scans or MRIs, to determine the primary cause, such as malignancy or bone growth. Blood tests may also be performed to determine the cause. Several conditions can resemble phthisis bulbi, such as a small, atrophic eye (eye shrinkage due to other causes).

Management

If phthisis bulbi has not yet occurred, your ophthalmologist will recommend treating the underlying disease first using steroids for autoimmune diseases and antibiotics for infections. If phthisis bulbi has occurred, treatment aims to relieve eye pain and improve cosmetic appearance, not to restore vision. Surgery is the only way to treat phthisis bulbi. The affected eye can be removed through enucleation.

A prosthetic eye is an option for cosmetic rehabilitation. This artificial eye is placed during surgery. The affected eye must first be removed (enucleation). Modern prosthetic eyes closely resemble natural eyes, allowing you to continue daily activities post-surgery.

Complications

Complications of phthisis bulbi include calcification or ossification of eye cells, resulting in bone formation inside the eye (intracellular bone). Complete vision loss can occur with phthisis bulbi. Depending on the cause, vision loss can also affect the healthy eye.

Prevention

Preventing phthisis bulbi involves treating your eye condition thoroughly. If you have associated diseases that are risk factors, you need regular eye exams to detect damage early. Treating and controlling the underlying disease is crucial to prevent further eye damage leading to phthisis bulbi. Consult your ophthalmologist about your eye condition.

When to see a doctor?

If you experience eye trauma, whether blunt or chemical, or have decreased vision accompanied by eye pain or persistent eye infection, see an ophthalmologist immediately to prevent further damage.

Looking for more information about other eye diseases, please visit our page here!