Bulging eyes, formally called exophthalmos, is an eye condition where the eyes bulge or protrude. This can cause double vision and, rarely, optic nerve compression. If the optic nerve is compressed, it can lead to permanent vision problems.

If you notice your eyes bulging, see a doctor as soon as possible. Seeking help quickly gives you the best chance of recovery with no permanent damage. (Learn More)

The primary cause of exophthalmos is thyroid eye disease, also called Graves’ ophthalmopathy. It is most common among middle-aged women and smokers. The disease causes the immune system to attack the muscles and tissue around the eyes, inflaming them and leading to a bulge.

While Graves’ ophthalmopathy is the most common cause of the condition, it is not the only cause. A variety of eye conditions, including cancer, could be to blame. (Learn More)

Treatment for exophthalmos depends on the cause and the severity. In some cases, only fairly mild treatment is enough to reduce bulging. In others, extensive treatment and surgery may be necessary. Severe cases can lead to permanent disfigurement that may misalign the eyes (although this can usually be at least partially fixed with surgery). (Learn More)

The prognosis for recovery depends on the root cause of the exophthalmos, the severity, and how quickly you were able to get your symptoms under control. Your doctor will be able to give you a specific idea of what to expect. (Learn More)

What Are Bulging Eyes?

exophthalmos

Bulging eyes, or exophthalmos, is a condition in which one or both eyes begin to bulge or protrude. The bulging can lead to double vision.

In rare cases, the optic nerve may be compressed. This can lead to permanent vision loss if not quickly addressed.

If you notice your eyes bulging or protruding, even if you are not certain it is the case, see a doctor. Permanent vision problems are usually avoidable if you are quick to seek medical help for exophthalmos.

In some cases, exophthalmos may make you unable to safely or legally drive. If your vision is affected, talk to a doctor about whether it would still be safe to drive or otherwise operate heavy machinery. Refer to local law about whether you can legally do so. If driving is legal but still deemed unsafe by a doctor, you should still avoid it.

Causes of Exophthalmos

The main cause of exophthalmos is Graves' ophthalmopathy, also known as thyroid eye disease.

This disease affects one in three people who suffer from an overactive thyroid gland. It is most common among middle-aged women and smokers.

Thyroid eye disease causes the immune system to attack fatty tissue and muscles around the eye. This then causes inflammation, which leads to the characteristic bulge.

In some cases, a person with an underactive thyroid gland can experience a similar problem. It is rare for someone with a normal thyroid gland to have thyroid eye disease, but it is possible.

Other conditions, unrelated to thyroid eye disease, can cause exophthalmos.

  • Eye injury
  • Blood vessel abnormalities in the eye
  • Infection of eye socket tissue
  • Bleeding behind the eye
  • Cancerous tumors near the eye

Newborns, who have shallower eye sockets, can also have exophthalmos.

Treating Exophthalmos

The correct treatment for exophthalmos is dependent on the cause. Regardless of the root cause, you should first see a doctor. From there, the doctor will help you determine what the problem is.

The initial treatment to the most common cause of exophthalmos, thyroid eye disease, is to correct your thyroid hormone levels. Medication can help your problem from worsening, but it will not always solve your eye symptoms.

The following may also be recommended by a doctor:

  • Stop smoking.
  • Wear sunglasses if you suffer from photophobia.
  • Raise your head using additional pillows while lying in bed.
  • Avoid irritants, such as dirt and dust, as much as possible.
  • Use eye drops to lubricate your eyes as needed.

woman using eyedrops in her eye

In some cases, this may be all you need, and your exophthalmos will go away with time. For more severe cases, you may need corticosteroids. These are often administered via an injection. Severe side effects are uncommon, but some people may experience agitation, headache, and sleep problems while on corticosteroids.

If corticosteroids prove ineffective, orbital or retrobulbar radiotherapy may be used on its own or in conjunction with corticosteroids. This type of treatment uses high levels of radiation to destroy cells and reduce swelling. When done correctly, the risks are mostly controlled to your eyes. Risks include short-term vision problems, cataracts, and (in rare cases) retinopathy, which can threaten eye sight.

In cases of severe or persistent exophthalmos, surgery may be necessary to reduce the swelling, improve vision, or improve the appearance of the eye. Generally speaking, this surgery will take one of three forms.

  • Eyelid surgery: This is when the eye is surgically altered to improve its appearance, position, or closure.
  • Eye muscle surgery: This surgery adjusts the muscles around the eye to align your eyes, helping to lessen double vision.
  • Orbital decompression surgery: Used to improve the appearance of the eye and reduce pressure on the optic nerve, this surgery involves removing a small amount of bone from the eye socket.

While some of the above applies to treating all causes of exophthalmos, it is generally assumed that thyroid eye disease causes the condition. If this is not the case, the treatment may be different.

Infections are generally treated with antibiotics, and abscesses sometimes need to be drained. The best way to approach cancerous tumors varies, but treatment can involve chemotherapy, radiotherapy, and surgery.

As with any treatment plan, always listen to your doctor. The timeframe for recovering from exophthalmos can sometimes be disheartening, but following your doctor’s advice gives you the best chance of full recovery.

Prognosis

If you are quick to see a doctor once you notice a problem, exophthalmos usually does not lead to permanent vision loss. The first goal is to get the inflammation under control. The appearance of the eye, the recovery timeline, and the potential for permanent damage depend on the severity of the exophthalmos.

If permanent damage is likely, even if only in terms of appearance, there are surgeries available to alter appearance and fix any misalignment of your eyes.

References

Overview: Exophthalmos (Bulging Eyes). (October 11, 2016). UK NHS.

Treatment: Exophthalmos (Bulging Eyes). (October 11, 2016). UK NHS.

What Eye Problems Does Graves’ Disease Cause? WebMD.

Graves’ Eye Disease. American Thyroid Association.

Bulging Eyes (Exophthalmos). WebMD.

Everything You Need to Know About Exophthalmos. (May 2017). MedicalNewsToday.