Phthisis bulbi is an ocular condition characterized by severe eye damage. Also called the end-stage eye, this condition is related to a variety of causes that lead to scarring, inflammation, and globe disorganization. The eyeball may look collapsed in form.
In terms of eye health, phthisis bulbi is considered the last stage. This means that treatment or surgery is necessary.
Since phthisis bulbi is a degenerative disease, the symptoms may appear and worsen over time. You might experience one or more of the following in the affected eye(s):
- blurry, cloudy vision
- floaters (dark spots that float across your eyes)
- light sensitivity
- tenderness around the eye
- visual loss
With phthisis bulbi, your eye globe also shrinks in size. The white part of the eye (sclera) may thicken. The sclera might also become so thick that it creates a folding effect on the eye.
During a CT imaging scan of the eye, your doctor may note calcification. This refers to calcium buildup in your tissues that can harden over time. Calcification sometimes has a tumor-like appearance that may be mistaken for another condition, such as cancer or bone growth.
Causes of phthisis bulbi may include:
- Infection. Untreated infections can lead to eye damage. This includes phthisis bulbi.
- Chronic retinal detachment. Retinal detachment is the process in which the retina separates from the choroid. This rare, but serious condition requires an emergency visit to a retinal specialist. A retinal detachment interferes with the blood flow through your eye, depleting necessary components such as oxygen. In turn, your eye tissues may get damaged or can die.
- Complications from surgery. Any type of surgery carries the risk of adverse effects. This includes eye surgery. Some people with phthisis bulbi may have tissue damage from eye surgery that develops into this condition.
- Long-term inflammation. Also called uveitis, long-term inflammation of the eye can damage related tissues. According to British researchers behind a study published in Acta Ophthalmologica, uveitis is the most common cause of end-stage eye.
- Persistent hyperplastic primary vitreous. Also known as PHPV, this is a genetic condition that’s present at birth. Babies born with PHPV have a malformed eye. Fetal eye development occurs between weeks 7 and 20 of gestation.
- Retinoblastoma. This condition refers to a mass that accumulates and calcifies on the eye. Eventually, the calcification can form a tumor-like entity. It’s most common in children and is curable. However, prompt treatment is required for a full recovery.
- Trauma to the eye. Significant injuries to your eye may eventually lead to phthisis bulbi. Even if your eye has healed from traumatic events, such as a car accident, there may be lingering tissue damage that you may not be able to see. Eventually, the tissues can break down and lead to further complications.
Upon a physical eye exam and with imaging tests, your ophthalmologist will recommend specific treatment measures. If full end-stage eye isn’t evident yet, there may still be time to treat the underlying causes. For example, steroids may help uveitis, while antibiotics can treat an infection. Immunosuppressing medications may be prescribed if an autoimmune condition is causing the eye damage.
Eye surgery is needed for more advanced cases of eye damage. For retinal detachment, a surgeon will need to reattach the retina to the choroid.
In total end-stage eye, a prosthesis may be needed. This comes in the form of a false eye that’s implanted via surgery. Your surgeon will first perform enucleation surgery, which involves the removal of the entire damaged eye. Both an orbital implant and prosthetic eye are inserted in its place. Prosthetic eyes have come a long way in recent years — they look real, and you’re still able to perform everyday tasks once you heal from the surgery.
Complications and associated conditions
In rare cases, such changes within ocular cells can create bone in the eyeball. This effect is called an intraocular bone.
Babies born with PHPV require special monitoring for further complications, such as cataracts, fibrosis, and retinal detachment.
Severe visual loss is possible with phthisis bulbi. You may become legally blind before losing your entire eyesight. Depending on the cause, visual loss may also spread to the other eye.
If you have an inflammatory condition or an autoimmune disease, it’s important to monitor your eyes for inflammation. The following conditions, according to the National Eye Institute, may be related to uveitis. These include:
- rheumatoid arthritis
- Ankylosing spondylitis (arthritis of the spine)
- ulcerative colitis
- multiple sclerosis
- Kawasaki disease (blood vessel inflammation)