Proptosis (Bulging Eyes)

What is proptosis?

Proptosis is when one or both of your eyes bulge from their natural position. The condition can affect your appearance, leaving you with a startled expression that doesn’t go away.

Proptosis can also make it difficult for you to blink. When you can’t blink, the protective outer layer of your eyes (corneas) doesn’t receive the lubrication it needs to do its job. You may be at risk for cornea damage. Some people experience other complications, like low vision or double vision (diplopia).

Other names for proptosis include bulging eyes, protruding eyes and exophthalmos.

What are the signs of proptosis?

When your eyes bulge, the white part of your eyes is more visible. In addition, your eyeballs push forward from your eye sockets. You may be able to see less of your upper eyelids because your eyes look like they’re wide open.

Other symptoms of a bulging eye that you may experience include:

• A gritty sensation when you move your eye.
• Dry, irritated or watery eye (epiphora).
• Eyelid swelling or redness.
• Muscle tightness that may prevent you from moving your eye.
• Sensitivity to light.
• Headache.
• Fever.

Are there symptoms I should be concerned about?

Symptoms of proptosis that need a prompt evaluation from a healthcare provider include:

• A throbbing sensation in your eyes.
• Eye bulging that comes on suddenly.
• Pain or redness.
• Symptoms in one eye.
• Loss or decrease of vision.
• Blurred or double vision.
• Difficulty focusing on objects.

What causes bulging eyes?

The most common cause of bulging eyes is an autoimmune disease in which your body’s immune system attacks cells in your thyroid gland and the tissue behind your eye. Proptosis in people with thyroid issues is also called thyroid eye disease (TED). People who have thyroid issues are the most likely to experience bulging eyes. Proptosis causes include:

• Graves’ disease.
• Hyperthyroidism (overactive thyroid gland).
• Eye socket infections.
• Injuries, especially if they cause bleeding behind your eye.
• Tumors, which may include neuroblastoma and some soft tissue sarcomas.

What are the complications and long-term effects of proptosis?

Most people don’t 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 can’t blink and lubricating eye drops aren’t effective.

How is proptosis diagnosed?

Your healthcare provider will ask about your symptoms and medical history to determine the potential causes of your bulging eyes.

They’ll also perform an eye exam that may include:

• Using a slit lamp to magnify your 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: This test uses a special instrument to measure how far your eyeball protrudes from your eye socket.
• Blood tests: This will likely include a workup for thyroid disease.
• Imaging studies: Imaging tests, like an MRI (magnetic resonance imaging) or a CT scan (computed tomography scan), can check for bleeding, tumors or signs of infection.
• Other lab tests: Lab tests, like a blood or tissue culture, can confirm or rule out an infection.

How is proptosis treated?

Your treatment may include:

• Artificial tears, including drops or gel, to relieve dry eyes and protect your corneas.
• Antibiotics if you have an infection.
• Medical treatments for underlying conditions, like medications for hyperthyroidism.
• Intravenous (IV) medications like corticosteroids (anti-inflammatory medication) or teprotumumab (Tepezza®) for thyroid eye disease.

Are there other nonsurgical treatments for bulging eyes?

Other therapies may include:

• Double vision treatments: These treatments include prisms that attach to your glasses and redirect light as it enters your eyes.
• Immunosuppressive drugs: These drugs may lessen the impact of immune system attacks on your eyes.
• Corticosteroids: You may receive steroids by injection or through a vein in your arm to relieve swelling or restore eyesight.

Will I need surgery?

You may need surgery to:

• Create more space behind your eye in the eye socket.
• Treat double vision.
• Protect your corneas if you can’t fully close your eyelids.
• Remove a tumor.

How can I prevent protruding eye symptoms from getting worse?

Steps you can take to prevent proptosis from getting worse 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.

What is the outlook for people with protruding eyes?

You’re 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.

Can a bulging eye go back to normal?

Yes. But even with successful treatment, it may take a while for your eye to return to its usual position. In some cases, it takes years.

What is life like with proptosis?

Protruding eyes can change 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 virtual resources if you’re unable to drive due to vision issues.