Bulging Eyes (Proptosis)
What is proptosis?
Proptosis is the bulging of one or both or your eyes from their natural position. The condition can affect your appearance, leaving you with a startled expression that doesn’t go away.
It’s also called exophthalmos.
How do protruding eyes affect my body?
Proptosis causes the eyes to bulge, making it difficult to blink. When you can’t blink, your eyes' protective outer layer (cornea) doesn’t receive the lubrication it needs to do its job. You may be at risk for cornea damage. Some people experience other complications, such as low vision or double vision.
Symptoms and Causes
What are the most common causes of proptosis?
The most common cause of bulging eyes is an autoimmune disorder in which the body’s immune system attacks cells in the thyroid gland and the tissue behind the eye. Proptosis in people with thyroid issues is also called thyroid eye disease.
Who is most likely to experience thyroid eye disease?
People who have thyroid issues, such as:
What are other causes of proptosis?
Other potential proptosis causes include:
- Eye socket infections.
- Injuries, especially if they cause bleeding behind the eye.
- Tumors, which may include neuroblastoma and some soft tissue sarcomas.
What are the signs of proptosis?
When your eyes bulge, the:
- White part is more visible.
- Eyeballs push forward from your eye sockets.
Are there symptoms that I should be concerned about?
Symptoms of proptosis that need a prompt evaluation from a healthcare provider include:
- A throbbing sensation in your eyes.
- Bulging that comes on suddenly.
- Pain or redness.
- Symptoms in one eye.
- Blurred or double vision.
What are the other symptoms of bulging eyes?
You may also experience:
- A gritty sensation when you move your eyes.
- Dry, irritated or watering eyes.
- Eyelid swelling or redness.
- Muscle tightness that may prevent you from moving your eyes.
- Sensitivity to light.
Diagnosis and Tests
How is proptosis diagnosed?
Your healthcare provider will ask about your symptoms and medical history to determine potential causes for your symptoms.
They also perform an eye exam that may include:
- Using a slit lamp to magnify the eye’s surface and structures.
- Assessing eye and eyelid movement.
- Checking for redness, soreness and irritation.
What other tests might I need?
Your healthcare provider may perform or recommend other tests, including:
- Exophthalmometry, which uses a special instrument to measure how far the eyeball is pushing out from the eye socket.
- Blood tests, including workup for thyroid disease.
- Imaging studies, such as an MRI or CT scan, to check for bleeding, tumors or signs of infection.
- Other lab tests, like a blood or tissue culture to confirm or rule out an infection.
Management and Treatment
How is proptosis treated?
Your treatment may include:
- Artificial tears, including drops or gel to relieve dry eyes and protect the cornea.
- Antibiotics if you have an infection.
- Medical treatments for underlying conditions, such as medications for hyperthyroidism.
- IV medication teprotumumab (Tepezza®) for thyroid eye disease.
Are there other nonsurgical treatments for bulging eyes?
Other therapies may include:
- Double vision treatments, including prisms that attach to your glasses and redirect light as it enters your eye.
- Immunosuppressive drugs, which may lessen the impact of immune system attacks on your eyes.
- Corticosteroids you receive by injection or through a vein in your arm to relieve swelling or restore eyesight.
Will I need surgery?
You may need surgery to:
- Remove a tumor.
- Create more space behind the eye in the eye socket.
- Treat double vision.
- Protect your cornea if you cannot fully close your eyelids.
How can I prevent protruding eye symptoms from getting worse?
Steps you can take include:
- Keeping thyroid levels in check: If you have thyroid disease, follow your healthcare provider’s care instructions. Take daily medications and stay current with blood testing to check thyroid levels.
- Quitting smoking: Smoking can make proptosis treatments less effective. Quitting can have a significant and positive impact on your body’s response.
Outlook / Prognosis
What is the outlook for people with protruding eyes?
You are more likely to have good outcomes if you receive timely treatment to address the cause of your symptoms. Getting the right therapies for your needs can also help you avoid complications.
How long will my eyes look like this?
Even with successful treatment, it may take a while for your eyes to return to their natural position. In some cases, it takes years.
What are the complications and long-term effects of proptosis?
Most people do not experience complications or long-term effects. In rare cases, double vision or vision loss may be permanent. It’s also possible to experience cornea damage if you cannot blink, and lubricating eye drops are not effective.
What is life like with proptosis?
Protruding eyes can affect your appearance and cause issues with your confidence and self-esteem. If it affects your vision, you may experience unexpected changes in your daily life. These changes can leave you feeling upset, anxious or depressed.
How can I cope with challenges?
Support from a mental health professional or social worker can help you feel better:
- Mental health professionals may use cognitive behavior therapy (CBT) to help you find methods for coping with negative thoughts and feelings.
- Social workers can connect you with local resources in your area, including support groups or transportation assistance.
A note from Cleveland Clinic
Proptosis can be due to a variety of causes from cancers to endocrine problems to variants of normal anatomy. Proptosis can permanently affect your vision. Your healthcare provider will determine the cause, which will help guide your treatment.
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