Exophthalmos is the medical term for bulging eyes. It typically develops from thyroid gland problems, such as Graves’ disease.1 Aside from bulging eyes, other symptoms include light sensitivity, double vision, and dry eyes.
If you notice one or both of your eyes bulging, see a doctor to check your eyes and get a blood test. You might have an underlying condition that requires treatment.
This article explains exophthalmos and covers its common causes and treatment options. Talk to a medical professional to determine the best exophthalmos treatment for you.
What is Exophthalmos (Bulging Eyes)?
Exophthalmos, also called proptosis, is a condition characterized by protruding eyes. It can affect one or both eyes, making it look like the eyeball protrudes from the eye socket. Upper eyelid retraction might also be present.
Exophthalmos is a sign of another problem, not a medical condition itself. The most common cause in adults is a thyroid eye disease, such as Graves’ ophthalmopathy (Graves’ disease).
Why is it Important to Treat Exophthalmos?
Depending on the underlying cause, exophthalmos may compress the optic nerve. This can lead to visual disturbances.
The optic nerve sends signals between the eyes and the brain. Compressing the optic nerve can affect your vision and cause permanent damage without prompt treatment.
When Should You See a Doctor?
You should see your eye doctor immediately if one or both of your eyes protrude.
While the condition might not be cause for concern, you don’t want to leave exophthalmos untreated. Exophthalmos can lead to severe cases that may cause permanent vision damage, like double vision or vision loss.5
What Causes Exophthalmos?
There are a few potential causes of exophthalmos, such as:
Thyroid Eye Disease
Thyroid eye disease, also known as Graves' ophthalmopathy or Graves’ disease, is the most common cause of exophthalmos.5 Thyroid eye disease is often related to thyroid hormone imbalances.
Graves’ disease is an autoimmune disorder. It occurs when the immune system attacks the muscles and soft tissue around the eyes. This causes inflammation and swelling, which can make the eyes bulge.
Symptoms of thyroid eye disease include:
- Eye redness
- Dry eyes
- A gritty sensation
- Vision problems
Your doctor will likely check your thyroid gland first to see if it’s causing exophthalmos.
Eye Injury or Bleeding Behind the Eyes
If you injure your eyes and bleeding occurs behind them, it can cause bulging.5 Getting a foreign object stuck in the orbit of your eye can also cause symptoms like corneal dryness, discomfort, and exophthalmos.
Seek emergency medical care if your eyes are bleeding from an injury or an object penetrating your eyeball. Any damage to healthy tissue behind the eyes can be painful and dangerous.
Abnormally Shaped Blood Vessels
Abnormally formed blood vessels behind the eye can push the eyeball forward.5 This can cause the eye to bulge outward.
Eye Socket Tissue Infection
If you have an infection, you may notice eyesight changes, like blurry or double vision and weak eye muscles.
An infection of the soft tissues in the eye sockets can also cause the forward displacement of the eyes.5
Cancer
In rare cases, cancerous tumors behind the eyes can cause symptoms like protruding eyes.5 Orbital tumors are a rare cause of orbital decompression.
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Exophthalmos (Bulging Eyes)
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Diagnosing Exophthalmos
Your doctor will review your symptoms and medical history to identify a possible underlying cause, such as an overactive thyroid gland.
They might perform an eye exam to:
- Evaluate your eye and eyelid movement
- Check for redness and swelling
- Examine your eye with a slit lamp
Imaging tests, such as a computed tomography (CT) scan and lab tests, might also be recommended. After determining the underlying cause, your doctor will recommend an appropriate treatment plan.
Exophthalmos Treatment Options
Treating exophthalmos involves treatment of the underlying cause.
If you have a thyroid eye disease, various medical specialists may collaborate on your treatment plan. This often includes eye care specialists, primary care physicians, and endocrinologists.
Depending on your needs, treatment might include:
Nonsurgical Treatments
About 66% of exophthalmos cases resolve within 6 months of conservative treatments.1
These include:
- Quitting smoking. Cigarette smoking increases the risk and severity of thyroid eye disease
- Artificial tears. Lubricating eye drops help relieve dry eyes and protect the cornea
- Sunglasses and protective eyewear. To help protect against light sensitivity and glare
- Double vision treatments. Such as a prism that attaches to your glasses
- Botulinum toxin injection. To correct upper eyelid retraction
- Corticosteroids. Oral and/or intravenous (IV) steroid medications will reduce inflammation
- Medications to treat autoimmune disease. Such as Graves’ disease
- Teprotumumab (Tepezza®). A new IV drug to treat thyroid eye disease
- Chemotherapy. To treat cancerous tumors
Surgery
You may need surgery to remove a cancerous tumor or if nonsurgical treatments fail to improve the condition.
Surgical decompression makes the eye socket larger so the eye, muscles, and soft tissues have more space.
Connection Between Hyperthyroidism and Exophthalmos
The level of thyroid hormones in your blood can cause bulging eyes. If your thyroid function is off and your thyroid hormone levels are too high, it can cause inflammation.
You’ll need a few blood tests to check your levels and confirm your thyroid problem.
Summary
Exophthalmos is also known as bulging eyes or proptosis. It’s not a condition itself but a symptom of another problem.
Thyroid eye disease is the most common cause of exophthalmos. This autoimmune disorder occurs when the immune system attacks the tissues surrounding the eyes. It’s typically due to an imbalance of hormones from the thyroid gland.
Effective exophthalmos treatment will vary depending on the underlying cause. The protruding eye or eyes usually get better within 6 months of conservative treatment. In some cases, surgical treatment is necessary.
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