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Bulging eyes (proptosis) could indicate thyroid issues, infection, or other conditions. Learn about causes, symptoms, treatment, and prevention
Bulging eyes (proptosis) could indicate thyroid issues, infection, or other conditions. In thyroid diseases, the immune system attacks the tissues around the eyes, causing the eye tissues and muscles to swell and push the eyeball forward.
The protrusion makes blinking difficult, leading to lack of lubrication of the cornea (outer protective layer of the eye). This puts the cornea at risk of severe damage that may result in poor vision.
What causes bulging eyes?
Causes of bulging eyes may include:
- Hyperthyroidism: Overactive thyroid gland
- Thyroid eye disease or Grave’s disease: Autoimmune disorder in which immune cells attack the thyroid gland, leading to inflammation behind the eyes
- Eye injury: Trauma to the eye can lead to swelling and bleeding, especially behind the eye.
- Eye infections: May include orbital cellulitis, which is a unilateral serious infection of the eye involving the muscles and fat within the orbit
- Glaucoma: Eye disorder characterized by increased pressure in the eyes due to fluid accumulation and damage to the optic nerve.
- Benign or malignant tumors:
- Neuroblastoma (nerve cell cancer)
- Rhabdomyosarcoma (soft tissue cancer)
- Hemangioma (abnormal growth of blood vessels)
- Non-Hodgkin’s lymphoma (cancer of the lymphatic system)
- Leukemia (blood and bone marrow cancer)
- Orbital pseudotumor: Benign, noninfective inflammatory condition of the orbit
- Sarcoidosis: Inflammatory connective tissue disease
- Histiocytosis: Group of disorders characterized by abnormally high immune cells called histiocytes
Bulging eyes, especially in children, could be a sign of a serious problem and needs immediate medical attention.
What are signs and symptoms of bulging eyes?
Bulging eyes are characterized by:
- More visibility of the sclera (white part of the eye) between the iris (colored part of the eye) and the upper eyelid
- Protrusion of the eyeballs from the sockets
Symptoms that require immediate medical evaluation include:
- Sudden and unexpected bulge
- Throbbing sensation in the eyes
- Severe pain and redness in the eyes
- Trouble moving the eyes
- Inability to close the eyes
- Blurred or double vision
- Loss of vision
- Fever
Other warning symptoms may include:
- Eye dryness, redness, or swelling
- Pressure and pain in the eyes
- Gritty sensation with eye movement
- Eyelid puffiness
- Watery eyes
- Blinking less often
- Staring appearance
- Light sensitivity (photophobia)
- Seeing halos around lights
- Headache
How is proptosis diagnosed?
If you develop bulging eyes, consult your doctor as soon as possible. Your doctor will ask about your symptoms and take your medical history to evaluate the potential cause.
- Medical history: To assess your eye symptoms, such as when and how the bulging started, and whether you are experiencing pain, itching or vision-related problems; also to assess you for hyperthyroidism, such as inability to tolerate heat, increased sweating, involuntary shaking, anxiety, increased appetite, diarrhea, palpitations, and weight loss.
- Eye examination: To examine your eyes under high magnification and determine the impact of the bulging on your vision.
- Blood test: To evaluate the thyroid levels, autoantibodies, and other relevant parameters.
- Exophthalmometry: To measure the degree of bulging.
- Computed tomography or magnetic resonance imaging scan: To check for tumors and internal bleeding.
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How are bulging eyes treated?
Treatment usually depends on the cause and severity of the condition and may include:
- Artificial tears, which includes lubricating drops and gels to relieve dryness and prevent corneal damage
- Antibiotics for infection
- Medications for hyperthyroidism (beta-blockers or antithyroid medications)
- Corticosteroids, such as prednisone, which may help control swelling caused by Grave’s disease or orbital pseudotumors
- Immunosuppressive drugs to reduce the negative immune response
- Surgical removal of tumors
- Chemotherapy or radiotherapy to treat malignant tumors
What are the complications of bulging eyes?
Potential complications of untreated bulging eyes include:
- Permanent double vision
- Permanent vision loss
- Corneal damage
- Decreased quality of life
Can bulging eyes be prevented?
Bulging eyes due to hyperthyroidism may be prevented to some extent. Preventive steps that can be taken include:
- Checking thyroid levels as advised by your doctor
- Taking prescribed thyroid medications regularly
- Quitting smoking, which can reduce the effectiveness of antithyroid medications and has a significant impact on immune response
Early and property treatment can help you avoid complications. However, bulging eyes may take a while to resolve and in many cases it takes years to return to normal.