Bulging Eyes (Exophthalmos or Proptosis): Causes & Treatment

Bulging eyeballs are also known as exophthalmos or proptosis. 

This is a medical condition that can affect one or both eyes. It is most commonly caused by a rare disease called thyroid eye disease. 

Since this condition can create compression of the optic nerve, it is essential to get immediate treatment. Left untreated, it can permanently damage your ability to see.

Causes of Bulging Eyes

Thyroid eye disease, also called Graves’ ophthalmopathy disease, is one of the primary causes of bulging eyes. Graves’ is an autoimmune condition, where the immune system attacks healthy tissue. The bulging eyes occur when the immune system mistakenly targets fat tissue and muscles of the eye. 

Other causes of exophthalmos and proptosis are less common and may include the following:

• Injury to the eye socket
• Eye infection 
• Abnormal blood vessels or bleeding behind the eyes
• Cancerous tumors

Bulging eyes may also rarely occur in newborns.

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Diagnosis

If you notice protrusion of one or both eyes, see your health care provider right away. You may notice the bulging because it’s hard to close your eyelids, or each of your eyes looks different. You may also notice double vision, decreased vision, swelling, irritation, or watery eyes. 

When your eyes bulge, more of the white portion of the eyes is visible. The eyeball pushes forward from your eye sockets. Your doctor will check your symptoms and evaluate potential causes.

After seeing your doctor, you may be referred to an ophthalmologist for in-depth diagnostic tests.

Testing often includes checking eye movement and measuring how far your eyeball is bulging. This is done with an exophthalmometer, a specialized instrument that measures the extent of the protrusion. 

Your doctor may recommend a CT scan, MRI scan, or ultrasound. Expect to have your thyroid hormone checked with blood tests.

As this condition is often caused by thyroid disease, you may be referred to an endocrinologist, a doctor specializing in treating thyroid function. 

Treatment of Bulging Eyes

Treatment for proptosis varies depending on the cause of the condition.

If thyroid eye disease is causing bulging eyes, the following treatments may be used: 

• Medication: This can manage thyroid hormone levels. Medication may be used to make sure that the condition does not progress. 

• Injections: Intravenous injections of steroids may help reduce inflammation.

• Surgery: Corrective surgery may be advised after the inflammation is controlled.

In addition, doctors may recommend these treatments:

• Eye drops to reduce irritation or sensation of dryness
• Special lenses to correct double vision

If an infection in the eye socket is causing bulging, antibiotics may be used for treatment. If any abscesses have developed, they may need to be drained.

If a tumor behind the eye is causing the eyes to bulge, treatment often involves chemotherapy, radiation, or surgery. 

As smoking increases the risk of this condition, your doctor will advise you to stop smoking. Quitting smoking can have a positive impact on the condition itself and make treatments significantly more effective.

Exophthalmos Complications

Complications vary depending on what is causing the eyes to bulge. 

If eyes are bulging due to thyroid eye disease, you may also notice other symptoms. In addition to bulging, you may experience the following issues:

• Red and inflamed eyes
• Pain
• Gritty and dry feeling
• Excessive tearing
• Increasing sensitivity to light
• Double vision
• Difficulty closing your eyes properly

If you have trouble closing your eyes completely, this can cause further damage and dryness. In severe cases, the eye can become very dry, developing ulcers or an infection. 

Without treatment, vision damage may occur. In rare cases, permanent vision loss or double vision is possible.

A further complication is a change in physical appearance that may cause feelings of anxiety, depression, or difficulty coping. Support from a mental health provider can help you find methods to cope. 

A practical complication of thyroid eye disease is that your ability to drive may be affected. Professional organizations or your medical provider may be able to refer you to resources that can assist with transportation.

When to See a Doctor

If you notice that one or both eyes are bulging, see a doctor or optician promptly. It is essential to act quickly, so treatment may start immediately. This is essential since the optic nerve may be affected, impairing vision.

Bulging Eyes FAQs

What can bulging eyes indicate?

Bulging eyes can indicate a thyroid eye disease known as Graves’ ophthalmopathy disease. This is a condition where the immune system attacks healthy eye tissue and muscles. Swollen eyes are commonly caused by this thyroid condition. 

Can you fix bulging eyes?

Yes, this condition can be treated with medicine, intravenous steroid injections, and corrective surgery. If a tumor is causing the eye to bulge, additional treatments may be necessary.

Treatment for thyroid eye disease tends to occur in two phases. The first is an active phase where you can experience a lot of dryness and redness. During this phase, you are at high risk for vision problems. This phase can last from two months to two years. 

The inactive phase is when the condition is under control, but you may still experience some protruding of the eyes.

What condition causes the eye to bulge?

Grave’s ophthalmopathy disease is the most common cause of eye bulging. For people with overactive thyroid glands caused by Graves’ disease, one in three is affected by eyes bulging. 

Eye bulging can also occur in people with underactive thyroids. It rarely occurs in people who have normal functioning thyroids.

References

1. Overview Exophthalmos (Bulging Eyes). (August 2022). National Health Service.

2. Thyroid Eye Disease. (2020). National Organization for Rare Disorders.

3. Bulging Eye. Tufts Medical Center.

4. Eyes – Bulging Information. Mount Sinai Hospital.

5. Bulging Eyes (Proptosis). (November 2021). Cleveland Clinic.

6. Exophthalmometer. American Academy of Ophthalmology.

7. CT (Computed Tomography) Scan. (November 2020). Cleveland Clinic.

8. MRI (Magnetic Resonance Imagining). (May 2022). Cleveland Clinic.

9. Ocular Ultrasound. (July 2021). StatPearls.

10. Cognitive Behavioral Therapy (CBT). (August 2022). Cleveland Clinic.