Exophthalmos (Proptosis): What You Need to Know About Bulging Eyes (2024)

Exophthalmos, also known as proptosis or bulging eye, is a condition characterized by the protrusion of one or both eyes from their normal position within the eye sockets. It's important to note that exophthalmos itself is not a specific condition but rather a sign of an underlying disorder. The most common cause of exophthalmos is Graves' disease, a thyroid disorder that leads to overactivity of the thyroid gland.

Symptoms of exophthalmos can vary in severity and may improve over time. However, without proper treatment, the eyes may continue to bulge, potentially causing discomfort and impacting vision.

Exophthalmos (Proptosis): What You Need to Know About Bulging Eyes (1)

Graves’ Disease and Thyroid Disorders: The Common Causes of Exophthalmos

Graves' disease affects the thyroid gland. In Graves' disease, the immune system mistakenly attacks the thyroid gland, leading to an overproduction of thyroid hormones called hyperthyroidism.

This excess thyroid hormone production can cause various symptoms, including bulging eyes or exophthalmos. The exact mechanism behind the development of exophthalmos in Graves' disease involves inflammation and swelling of the tissues behind the eyes, leading to the protrusion of the eyes from their sockets.

Causes of Exophthalmos

Exophthalmos can also result from various underlying conditions that affect the tissues around the eyes or the eye itself.In children, the most common cause of exophthalmos is an infection (cellulitis) in or around the eye.

Other potential causes of exophthalmos include:

Signs of Exophthalmos

Symptoms that someone with Graves' disease and exophthalmos may experience include:

Bulging or protrusion of one or both eyes
Dry, irritated, or gritty sensation in the eyes
Swelling or puffiness around the eyes
Double vision or blurred vision
Eye discomfort or pain
Sensitivity to light (photophobia)
Difficulty closing eyelids completely
Redness or inflammation of the eyes (conjunctivitis)
Trouble moving the eye when you look around

These symptoms can vary in severity and may fluctuate over time. Individuals with Graves' disease or exophthalmos need to seek medical evaluation and management to address both the thyroid disorder and eye-related symptoms effectively.

Symptoms That Signal You Need a Prompt Medical Evaluation

See your healthcare provider if you experience any of the symptoms of bulging eyes mentioned above. They are likely part of a larger medical issue that requires medical treatment and guidance.

It's essential to contact a medical professional if:

You experience bulging eyes without a known cause.
Bulging eyes are accompanied by additional symptoms like pain or fever.

Your healthcare provider will inquire about your medical history and conduct a physical examination. They may ask questions such as:

Are both eyes affected?
When did you first notice the bulging?
Is the condition worsening?
What other symptoms are you experiencing?

How Exophthalmos Is Diagnosed

Exophthalmos is typically diagnosed through a series of steps. Your healthcare provider will ask about your symptoms, when they started, any associated conditions, and your overall health history. They will also thoroughly examine your eyes, including measuring how far your eyes protrude, assessing eye movement, and checking for signs of inflammation or other abnormalities.

Additional tests may include:

Visual acuity test: This can determine if there are any vision changes.
Slit-lamp examination: This specialized eye exam uses a microscope with a bright light to examine the eye's structures in detail, looking for signs of eye disease or injury.
Imaging tests such as computed tomography (CT scan) or magnetic resonance imaging scans (MRI): May be ordered to obtain detailed images of the eye sockets and surrounding structures.
Blood tests: These can check thyroid hormone levels. Exophthalmos is commonly associated with thyroid disorders like Graves' disease.

These diagnostic steps help your healthcare provider determine the cause of your bulging eyes and develop an appropriate treatment plan.

How Exophthalmos Is Treated

Fortunately, effective treatments are available. Some self-care options can be utilized without medication, while others should be advised or prescribed by your healthcare provider. In some instances, surgical intervention may be necessary.

Treatments will vary based on your condition's underlying cause, which may include artificial tears to lubricate and protect the surfaces of the eyes (your corneas).

Here are some self-care strategies you can implement:

Protect your eyes from sunlight with sunglasses, especially if they're sensitive. Wear wraparound sunglasses for optimal sun and wind protection.
Relieve dryness and discomfort with lubricating eye drops, such as artificial tears.
Apply a lubricating gel before bedtime if your eyelids don't close fully to prevent dryness.
Elevate the head of your bed to alleviate pressure on your eyes, which can help reduce swelling and puffiness.
If double vision occurs, your eye doctor may prescribe glasses with prisms.

If an infection is causing the issue, antibiotics are prescribed to clear the infection. Moderate to severe cases may require oral or intravenous corticosteroids, which your healthcare provider must prescribe.

Surgery is only required in a smaller number of people with exophthalmos. There are several types of eye surgeries for bulging eyes, such as:

Orbital decompression surgery

This procedure involves removing bone from the eye socket (orbit) to create more space for the swollen tissues behind the eyes. By reducing pressure within the orbit, orbital decompression surgery can alleviate symptoms such as bulging eyes and eye discomfort.

Strabismus surgery

If bulging eyes lead to double vision (diplopia) due to misaligned eye muscles, strabismus surgery may be recommended. This surgery adjusts the positioning of the eye muscles to realign the eyes, reducing double vision.

Orbital fat removal

This procedure involves removing excess fat from the eye socket through an incision inside the lower eyelid. It can help reduce the bulging appearance and alleviate pressure on the eyes.

Potential Complications of Exophthalmos

More advanced stages of exophthalmos may compromise your ability to fully close your eyes. This can lead to dryness of the corneas, which are the clear protective layers covering the front of your eyes. Prolonged corneal dryness increases the risk of infections or ulcers, which, if not treated promptly, could result in vision impairment.

What’s the Outlook for Someone With Exophthalmos?

The outlook for someone with exophthalmos depends on the underlying cause and severity of the condition. In many cases, with appropriate treatment and management of the underlying condition (e.g., thyroid eye disease or orbital tumors), the outlook is favorable, and symptoms can be controlled.

However, complications like vision impairment or corneal damage may occur in severe or untreated cases. That is why timely medical intervention is so essential.

Prevention and Self-Care Strategies

To prevent exophthalmos or manage its effects:

Avoid smoking and minimize exposure to secondhand smoke.
Apply lubricating eye drops or gels as prescribed to maintain eye moisture and prevent dryness.
Wear sunglasses and protective eyewear to help protect against light sensitivity.
Follow your healthcare provider's recommendations for managing thyroid-related conditions to reduce the risk of eye complications.

When to Contact a Healthcare Provider

If you notice bulging eyes, contact your healthcare provider promptly, especially if the bulging is sudden, severe, or accompanied by other symptoms. Additionally, if you have a known thyroid disorder like Graves' disease or are experiencing eye discomfort or changes in vision, seeking medical attention is crucial.

Here are specific situations in which it's important to contact a medical provider regarding bulging eyes:

Sudden onset of bulging eyes
Severe bulging that affects vision or causes eye discomfort
Presence of other symptoms such as double vision, eye pain, redness, or fever
Known thyroid disorders like Graves' disease or Hashimoto's thyroiditis
Changes in eye appearance, including protrusion or enlargement of one or both eyes

Summary

Exophthalmos, also known as bulging eyes or proptosis, can signal underlying conditions like Graves' disease or orbital tumors. Symptoms may include eye protrusion, dryness, double vision, and discomfort, requiring prompt medical evaluation, especially if accompanied by other symptoms or a known thyroid disorder.

Treatment options range from self-care measures like lubricating eye drops to surgical interventions such as orbital decompression or strabismus surgery, depending on the severity and cause of the condition. Early detection, proper management, and regular follow-ups are key to achieving favorable outcomes and preventing potential complications. If you or a loved one is experiencing symptoms, talk to your healthcare provider right away.