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Phthisis Bulbi: Symptoms, Causes, and Treatment

By Nethradhama Medical Staff
Reviewed by - Dr. Samhitha H R

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When an eye loses its sight, in rare but serious cases, this transformation takes the form of phthisis bulbi. This is a condition where the eye gradually loses shape, shrivels from within, and eventually stops responding to light or movement. Though irreversible, it’s not hopeless. Understanding its progression and knowing your choices can offer comfort, control, and the courage to act early.

What is Phthisis Bulbi?

Phthisis bulbi refers to a severely damaged eye that has lost both its structure and function. Poor vision barely scratches the surface of what phthisis bulbi entails. It’s an end-stage outcome of long-standing trauma, disease, or post-surgical issues where the eyeball literally collapses inwards, loses pressure, and often becomes disfigured. Inside such an eye, the retina may detach, the cornea might turn opaque, and the internal structures can harden. In some cases, the eye appears sunken and shrunken; in others, it’s clouded or misshapen.  While phthisis bulbi doesn’t cause pain in every patient, many experience discomfort due to calcification, inflammation, or underlying scar tissue. In essence, it is not only a medical concern but an emotional and cosmetic one as well. Because the changes are permanent, this condition doesn’t improve on its own. But medical advances today offer supportive treatments to address appearance, manage phthisis bulbi symptoms, and prevent complications in the other eye.

Who is at risk for phthisis bulbi?

Anyone with a severely injured or diseased eye could develop phthisis bulbi.  Some groups face higher vulnerability due to underlying risks. Patients with long-standing uncontrolled uveitis, those who have suffered major eye trauma, or individuals with repeated intraocular surgeries are more likely to experience this outcome. An undiagnosed retinal detachment or infections that affect the inner eye layers also increase the chances. Children who suffer blunt eye injuries while playing or individuals exposed to workplace hazards without protection are particularly at risk. Similarly, people with advanced glaucoma, severe diabetic eye disease, or tumours in the ocular region may end up with irreversible eye damage over time. In some cases, complications from intraocular silicone oil used during retinal surgery can also lead to a phthisical eye. What makes this issue so concerning is that it often follows a period of neglect. This is when a minor problem was left unchecked until it spiralled beyond repair. Spotting early signs like discomfort, recurring redness, or unexplained pressure shifts can halt the condition in its tracks.

Phthisis Bulbi Causes

Rarely does phthisis bulbi appear overnight. In fact, it builds. One of the most common triggers is a penetrating eye injury, such as those caused by sharp objects, blunt force trauma, or surgical complications. These injuries disrupt the delicate structures of the eye, setting off a cascade of inflammation, bleeding, or infection. Long-term inflammation, especially from autoimmune problems, silently chips away at the eye’s internal balance. Uveitis, when not properly controlled, leads to scarring and progressive shrinkage of the eye. Untreated retinal detachment, particularly when fluid accumulates beneath the retina, deprives the eye of its nourishment and triggers tissue collapse. Eye tumours, certain degenerative conditions, and failed surgeries (such as retinal reattachments or cataract extractions in high-risk eyes) also lie behind many phthisis bulbi cases. In rare scenarios, complications from congenital abnormalities may also lead to a phthisical eye in early childhood. By the time these root issues advance to the point of phthisis, the damage is extensive and non-recoverable.

Phthisis Bulbi Symptoms

Early phthisis bulbi symptoms can be subtle. What may begin with blurred vision in one eye might progress to complete sight loss if underlying inflammation or trauma remains untreated. As the situation worsens, the eye may sink into its socket or look pale and irregular, almost like a shadow of its former self. A dull ache behind the eye may be the first physical clue. For others, there may also be pressure behind the eye, especially when calcification or internal swelling is involved.  Others feel irritation due to a dry, uneven surface or corneal scarring. In rare cases, the damaged eye becomes tender to touch, particularly if there’s residual active disease. The difference becomes noticeable aesthetically. The affected eye may recede into the socket, with drooping eyelids or a milky white cornea giving the appearance of a lifeless organ. While not all cases cause physical discomfort, the psychological and social impact of phthisis symptoms can be significant.

How to diagnose Phthisis Bulbi

Diagnosis involves more than just observing a disfigured eye.  An ophthalmologist will use tools like slit-lamp examination, ultrasound imaging, and intraocular pressure measurements to confirm if the eye is truly phthisical. These tests help assess the degree of structural collapse, presence of scarring, or calcified lens matter within the globe. Imaging the retina and examining the cornea can provide critical clues about how advanced the condition is. Sometimes, specialised tests are needed to differentiate phthisis bulbi from other causes of eye shrinkage, such as micropthalmia or trauma-induced globe atrophy. The diagnosis may also include a full history, i.e., looking back at prior injuries, surgeries, or inflammatory situations that could have led here. In children or those with developmental issues, genetic or systemic workups may be suggested. Tagging the stage of the damage helps plan the next steps. In phthisis bulbi stages, reflecting increasing structural compromise, the condition is typically irreversible at all stages. Early intervention, however, may support better cosmetic outcomes.

Phthisis Bulbi Treatment Options

There’s no way to reverse this condition. However, several phthisis bulbi treatments exist to improve comfort, cosmetic appearance, and psychological well-being.  Damaged eyes that continue to irritate the surrounding tissues may benefit from anti-inflammatory drops. In more advanced cases, surgery may be considered. If the eye is painful, removal of the eyeball (enucleation) or the contents of the eye (evisceration) may be advised. These procedures, though emotionally difficult, often help patients regain confidence, especially when followed by prosthetic eye fitting. Modern ocular prostheses are lifelike and custom-designed to match the colour, shape, and movement of the other eye. They don’t restore sight, but they do restore symmetry, which can greatly improve self-esteem and social comfort. These prostheses require occasional cleaning and replacement to maintain hygiene and fit. For those with partial phthisis eye, a cosmetic shell worn over the natural eye may suffice i.e., a less invasive option that still offers visual harmony. The choice between treatments depends on the stage of phthisis bulbi, the presence of symptoms, and the patient’s personal goals.

Conclusion

Phthisis bulbi might seem like an ending. Treatment may not return vision, but it can restore dignity, ease discomfort, and open the door to emotional healing. Whether caused by trauma, disease, or years of silent progression, this state doesn’t have to rob someone of respect or peace of mind.

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