Bulging Eyes or Proptosis

Bulging eyes may be inherited, but most cases they are related to a problem with the thyroid. Read more about the symptoms, causes, and treatment of bulging eyes.

bulgingeyes

Proptosis, or exophthalmos, is the bulging out of one (unilateral) or both (bilateral) of the eyes. Cases of proptosis develop for reasons ranging from variations in our anatomy to the development of another condition such as hyperthyroidism, of which bulging eyes are a symptom. If a person suddenly develops proptosis, especially in both eyes, it is considered a very serious problem. Sudden onsets of proptosis should always be evaluated by an eye doctor immediately.

In mild cases of proptosis, a doctor can take measurements with a special ruler known as an exophthalmometer. If measurements are within a certain range, more testing is unnecessary. If measurements are out of the normal range, however, other tests will be conducted, possibly including an MRI, blood work, ultrasound, or even a biopsy.

Proptosis can become a very serious situation for some people. The bulging orbit may increase the intraocular pressure behind and inside the eye. As the intraocular pressure increases, so do risks for other eye diseases such as glaucoma.

Other Terms for Bulging Eyes

There are many different names experts use when referring to bulging eyes, such as:

  • Proptosis
  • Protruding Eyes
  • Exophthalmos
  • Bulging Eyes

Bulging Eyes Symptoms

Normally, there should be no visible white between the top of the iris (the colored part of the eye) and the upper eyelid. Visible white in this area is usually a sign of abnormal eye bulging. There are other symptoms that can accompany bulging eyes, including:

  • Difficulty closing eyes fully while sleeping or blinking
  • Drying of the cornea
  • Discomfort
  • Scarring which can lead to permanent vision loss
  • Difficulty with eye movement
  • Increase in visible sclera (the white part of eye)

Causes of Bulging Eyes

There is almost always an underlying cause for bulging eyes, and it is often related to the thyroid. If you were born with prominent eyes—that is, if it is genetic—it is usually not too big a problem, but you still should have your eyes looked at by a doctor to be sure there is not an underlying condition lurking. Many people fail to recognize early in life that they have this gene.

It is important to know that prominent eyes and bulging eyes are two different things. The best way to see whether your eyes are bulging is to compare present-day photographs of yourself with photos taken ten to twenty years ago. There are numerous causes for bulging eyes, such as:

  • Glaucoma
  • Graves’ disease
  • Hemangioma
  • Histiocytosis
  • Hyperthyroidism
  • Hyperthyroidism caused by medications for other conditions
  • Leukemia
  • Orbital cellulitis
  • Carotid-cavernous sinus fistula
  • Periorbital cellulitis
  • Neuroblastoma
  • Retinoblastoma
  • Rhabdomyosarcoma
  • Hemorrhages behind the eye
  • Injury to the eye

Treatment for Bulging Eyes

The best way to treat bulging eyes depends on the underlying cause. Medications such as corticosteroids may sometimes help reduce inflammation behind the eye. In more serious cases, plastic or reconstructive surgery may be necessary. In severe cases, orbital decompression may be performed; typically, orbital decompression is performed on people with Graves’ disease. The procedure involves either partially or completely removing one or more of the four walls of the eye socket (orbit). The purpose of the decompression is to allow some of the fat tissue behind the eye to exit the orbit, which allows the eyeball to sink back into the socket and appear more natural.

Preventing Bulging Eyes

In some cases, prevention of bulging eyes is impossible. If you have inherited the gene, or if you have a condition such as hyperthyroidism, there is nothing you can do to prevent your eyes from bulging. In most hereditary cases of proptosis, however, the condition is not incurable. Talk with your eye-care provider or medical doctor about possible steps you can take to prevent proptosis.

Talking to Your Eye Doctor

Here are some questions to ask your eye doctor about bulging eyes:

  • What has caused my eyes to bulge out?
  • Which treatment options are available to me?
  • Which treatment option(s) do you recommend?
  • Are there any over-the-counter products I could take to reduce the bulging?
  • How often should I see you for follow-up visits?
  • What should I expect during my follow-up visits?
  • What can I do to prevent my condition from worsening?

Did you know…among people with thyroid disease, only 5 percent experience eye problems such as bulging eyes.

References:
  • J. Lavine, MD “The Eye Care Sourcebook” (McGraw-Hill Companies, 2001) 253
  • J. DiGirolama, MD “The Big Book of Family Eye Care” (Basic Health Publications, 2011) 221-222
This article was last updated on 04/2014