Phthisis Bulbi (End-Stage Eye)

What is phthisis bulbi?

Phthisis bulbi (TYE-suhs bul-BEE) is the medical term for your eye after damage causes it to stop working forever. Another name for phthisis bulbi is end-stage eye. Causes include anything that badly injures your eye or its parts. You’ll permanently lose vision in your affected eye if you have phthisis bulbi. You also won’t be able to move or control that eye.

Phthisis bulbi is different from common age-related eye problems. Age or the natural result of your eye changing over time don't cause it. It happens when something damages your eye so badly that there isn't treatment, and it won’t heal.

Damage that permanently stops your eye from functioning causes phthisis bulbi. The damage can happen suddenly (like during a trauma) or over time (as a result of conditions that cause inflammation in your eyes). The parts of your eye that can be affected by phthisis bulbi include your:

• Sclera: Your sclera is the white part of your eye. Phthisis bulbi will make it thicken and stiffen.
• Retina: The retina is the layer at the back of your eye that converts light into electrical signals your brain uses to create your vision. Phthisis bulbi permanently damages your retina’s ability to function correctly.
• Cornea: The cornea is the clear part at the front of your eye that helps you focus on objects. If you have phthisis bulbi, your cornea can become stiff and cloudy.
• Iris: The iris is the colored part of your eye. Phthisis bulbi can lead to neovascularization of the iris.

Your eye’s appearance will also change. It'll look different than it usually does — and different from your other eye. These changes can include:

• Shrinking (atrophy).
• Looking more squared than rounded.
• Scarring inside your eye.
• Looking sunken (pseudo enophthalmos).
• Looking cloudy.

There's no treatment for phthisis bulbi, and healthcare providers can't repair the damage it causes. However, an eye care specialist can treat many of the conditions that eventually lead to end-stage eye before the conditions cause irreversible damage.

Visit an eye care specialist if you notice any changes in your eyes or vision. The sooner a specialist diagnoses your symptoms, the less likely it is the symptoms will lead to phthisis bulbi.

Who is affected by phthisis bulbi?

Phthisis bulbi typically affects people older than 65. They’re more likely to develop health conditions that can damage their eyes.

However, anyone can develop end-stage eye. Kids and younger adults can develop phthisis bulbi after a trauma or because of a congenital condition (diseases or disorders you’re born with).

People with certain autoimmune diseases might have a higher risk of developing phthisis bulbi. Inflammation that happens a lot (chronic inflammation) can damage your eyes over time. Talk to an eye care specialist about your risk factors. Some common inflammatory diseases that can lead to phthisis bulbi include:

• Psoriasis.
• Rheumatoid arthritis.
• Psoriatic arthritis.
• Ankylosing spondylitis.
• Ulcerative colitis.
• Sarcoidosis.

What are the symptoms of phthisis bulbi?

Vision loss in your affected eye is the most obvious symptom of phthisis bulbi. This blindness will be permanent and untreatable. An eye care specialist might refer to this blindness as disorganization — the medical term for untreatable changes inside your eye.

Phthisis bulbi symptoms include:

• Vision loss.
• Light sensitivity.
• Pain.
• Seeing floaters and flashes.
• Strabismus.

What causes phthisis bulbi?

Anything that damages your eye enough to permanently stop it from working can cause phthisis bulbi. The most common causes include:

• Traumas like eye injuries.
• Infections.
• Retinoblastoma and other types of cancer.
• Birth defects and other congenital conditions.
• Complications during and after eye surgery.
• Radiation therapy.
• Sickle cell disease.

Eye conditions that cause phthisis bulbi

Conditions that damage your eye over time can lead to phthisis bulbi. The most common eye conditions that cause end-stage eye include:

• Repeated (chronic) detached retinas.
• Uveitis.
• Coats disease.
• Retinopathy of prematurity.
• Diabetes-related retinopathy.

How is phthisis bulbi diagnosed?

An eye care specialist will diagnose phthisis bulbi with an eye exam. They’ll look at your eye (including inside it) for signs of scarring and other damage that means you have end-stage eye.

You might need a CT scan or MRI to take pictures of your eye and the tissue around it.

How is phthisis bulbi treated?

There’s no treatment for phthisis bulbi that'll restore your vision. By the time you have end-stage eye, the damage to your eye is irreversible.

Your eye care specialist might recommend removing your affected eye and replacing it with a prosthetic (artificial replacement) eye. The specialist can match your prosthetic eye with your healthy eye. This is a cosmetic procedure. It can’t restore your vision.

Removing your affected eye can eliminate pain and swelling.

How can I prevent phthisis bulbi?

The only way to prevent phthisis bulbi is to see an eye care specialist as soon as you notice any changes in your eyes or experience new symptoms. An eye care specialist can diagnose and treat many of the conditions that lead to end-stage eye before they cause permanent damage.

You can’t prevent a trauma from causing phthisis bulbi. Make sure you’re wearing proper eye protection for any sport or activity that could cause an eye injury.

How often should I have my eyes examined?

Having your eyes and vision checked regularly can help your eye care specialist identify problems right away. How often you get your eyes checked usually depends on your age:

• Adults younger than 40: Every five to 10 years.
• Adults between 40 and 54: Every two to four years.
• Adults older than 55: Every one to three years.

You might need eye exams more often than this if you wear glasses or contacts or need another type of visual aid. If you have diabetes, you must get eye exams more frequently.

Ask your eye care specialist how often you need an eye exam.

What can I expect if I have phthisis bulbi?

You should expect phthisis bulbi to be permanent. Once a specialist diagnoses phthisis bulbi, it's too late to treat it or restore your sight.

You might have other symptoms or complications depending on what caused phthisis bulbi, especially if you experienced a trauma. Talk to your healthcare provider about what to expect.

When should I see my healthcare provider?

Visit an eye care specialist as soon as you notice any changes in your eyes or vision. Getting a specialist to examine new symptoms before the cause of your symptoms can damage your eyes is the only way to prevent phthisis bulbi.

Go to the emergency room if you’ve experienced a trauma, or if you experience a sudden loss of vision.

What questions should I ask my doctor?

• What caused phthisis bulbi?
• Will I need a prosthetic eye?
• How often should I have my healthy eye examined?