Exophthalmos (Bulging Eyes): Causes & Treatment

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What is Exophthalmos (Bulging Eyes)?

Exophthalmos, also known as proptosis, refers to a condition characterized by bulging eyes.5 It can affect one or both eyes, and it looks like your eyeball is protruding out of your eye socket. Upper eyelid retraction may also be present.

Exophthalmos is the protrusion of the eye anteriorly out of its orbit, which happens because of an increase in orbital contents within your eye’s rigid bony orbit.1

With exophthalmos comes a slight risk of compressing your optic nerve. The optic nerve sends signals between your eyes and your brain.5 Compressing the optic nerve can affect your vision and cause permanent damage if you do not treat it promptly.

If you notice that one or both of your eyes is bulging, talk to your doctor to get a blood test and have your eyes checked out. There may be an underlying cause for concern, such as an underlying medical condition.

What Causes Exophthalmos?

There are a few different causes of exophthalmos. Here are some for reference.

Thyroid Eye Disease

Thyroid eye disease, which is also known as Graves' ophthalmopathy, is the most common cause of exophthalmos.5 If your thyroid hormones are at abnormal levels (e.g., if you have an overactive thyroid gland), it can affect your glands and hormones, causing abnormal bulging of the eyes.

Your doctor will likely check your thyroid gland first to see if it is the cause of exophthalmos.

Eye Injury or Bleeding Behind the Eyes

If you injure your eyes and cause bleeding behind them, this can cause them to bulge.5 If you get any foreign matter stuck in the orbit of your eye due to trauma, this can also cause symptoms like corneal dryness, discomfort, and exophthalmos.

In this case, immediate medical attention and care from an eye specialist are necessary. Any damage to healthy tissue behind the eyes can be very painful.

Abnormally Shaped Blood Vessels

Abnormally formed blood vessels behind the eye can cause abnormal protrusion, pushing your eyeball forward.5

Eye Socket Tissue Infection

If you have an infection, you may notice changes to your eyesight, like blurry or double vision, and weak eye muscles. But there are other signs, as well. An infection of the soft tissues in the eye sockets can also cause the forward displacement of your 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.

Connection Between Hyperthyroidism and Exophthalmos

The level of thyroid hormones in your blood can cause bulging eyes. This is because, if your thyroid function is off and your levels are too high, it can cause inflammation. You will need to do a series of blood tests to check your levels and confirm that you have a thyroid problem.

When Should You See a Doctor?

You should see your eye doctor immediately if you notice that one or both of your eyes are protruding. While your condition may not be cause for concern, you do not want to leave exophthalmos untreated. If left untreated, exophthalmos can lead to severe cases that may cause permanent vision damage like double vision or vision loss.5

Diagnosing Exophthalmos

If you have inflamed and red bulging eyes that feel painful, you may be dealing with exophthalmos. Your eyes may also be tearful and sensitive to light.

Your doctor will run a series of tests on you to collect medical information, identify a possible underlying cause (like an overactive thyroid gland), and provide you with a treatment plan. That may or may not include surgery.

Treatment Options for Exophthalmos

Fortunately, treatment for exophthalmos does exist. Refer to your ophthalmologist, as you will need tests and magnetic resonance imaging to diagnose your condition.6

Treating exophthalmos often involves surgery. You may need medication to treat thyroid eye disease, as well. With thyroid associated ophthalmopathy, patients may use propylthiouracil (an oral medication for hyperthyroidism) followed by surgery, propylthiouracil and then radioactive iodine, or any one of them alone.4 Methimazole and teprotumumab are also available. 

Or, you may need chemotherapy to reduce a tumor if cancer is at the root of what is pushing your eyeball outwards. If you have an autoimmune condition, your doctor may prescribe you other treatments.

In the meantime, your doctor may also give you eye drops and other pain medications to better manage the symptoms.

Exophthalmos: Common Questions and Answers

Here are answers to some of the most frequently asked questions about exophthalmos:

What is the difference between exophthalmos and proptosis?

Exophthalmos is also known as proptosis.

Can exophthalmos cause blindness?

Yes, if you do not treat exophthalmos right away, it can lead to permanent vision damage and loss.

What is exophthalmos a symptom of?

Exophthalmos may be a symptom of various causes, such as thyroid eye disease, eye injury, abnormally shaped blood vessels behind the eyes, an infection of the eye socket tissue, cancer, and other eye conditions.

Can exophthalmos go away on its own?

Exophthalmos will not typically go away on its own. You should seek medical care from an eye doctor immediately if you notice that your right or left eye, or both, are protruding. While the symptoms may just be uncomfortable at first, if you leave exophthalmos untreated for too long, it can lead to serious damage and vision loss.

Delayed diagnoses may also be life-threatening.5

Often, exophthalmos requires surgical treatment. If exophthalmos is occurring because of your thyroid hormone levels, you will need to treat those, as well.

What drugs can make your eyes bulge?

There are some drugs that you may take that can make your eyes bulge as a reaction. Consult your doctor if you are taking any medications that cause your eyes to bulge or that impair your visual acuity.

Resources
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Butt, Shamus. “Exophthalmos.” StatPearls [Internet]., U.S. National Library of Medicine, 25 Feb. 2021, www.ncbi.nlm.nih.gov/books/NBK559323/.

“Eyes - Bulging.” Mount Sinai Health System, www.mountsinai.org/health-library/symptoms/eyes-bulging.

“Eyes - Bulging: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/ency/article/003033.htm.

Grant Gwinup, MD. “Effect on Exophthalmos of Various Methods of Treatment of Graves' Disease.” JAMA, JAMA Network, 16 Apr. 1982, jamanetwork.com/journals/jama/article-abstract/371370.

NHS Choices, NHS, www.nhs.uk/conditions/bulging-eyes/.

“Proptosis.” Proptosis : Eye Symptoms & Signs : The Eyes Have It, kellogg.umich.edu/theeyeshaveit/common/proptosis.html.

Thomas, Keisha. “Proptosis (Bulging Eye).” Loyola Medicine, 25 Sept. 2020, loyolamedicine.org/ophthalmology/proptosis-bulging-eye.

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