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Bulging Eyes - Causes, Symptoms, and Management

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Bulging eyes are also known as exophthalmos, which denotes the bulging or protrusion of eyes from their anatomical position. Read this article to know more.

Written by

Dr. Sumithra. S

Medically reviewed by

Dr. Shachi Dwivedi

Published At October 7, 2022
Reviewed AtOctober 7, 2022

Introduction:

A body structure not in its normal anatomical position denotes a severe underlying medical condition. Likewise, bulging eyes or eyeballs, also known as proptosis or exophthalmos, are characterized by eyes that are not in their normal position. It can be caused by various underlying medical conditions, which will be discussed in detail in this article.

So how do we know if our eyes have bulged? Ideally, the upper white part of the eye should not be visible to the naked eye without lifting the upper eyelid. In case the eyes have bulged, the upper white part of the eyes will be visible without even lifting the upper eyelid. Bulging eyes can cause various complications, like double vision, but permanent vision loss is very rare, and in most cases, the condition can be managed.

What Are the Common Causes of Bulging Eyes?

The most common cause of a bulging eye is hyperthyroidism. The thyroid gland situated on the front side of the neck is responsible for producing hormones that will keep the metabolism functions in check. If the thyroid gland produces more hormones than needed, the condition is known as hyperthyroidism. Grave’s disease is a type of autoimmune disease, and it causes both hyperthyroidism and bulging eyes. So basically, the tissue surrounding the eye structure will undergo inflammation and result in protrusion of the eye. Grave’s disease commonly affects females aged 30 to 60 years.

There are a few conditions that may cause bulging eyes. They are as follows:

  • If an individual succumbs to an injury in the eye and it starts bleeding in the inside region of the eye, bulging eyes can be noticed.

  • If there is a condition that includes an abnormal collection of blood, then bulging eyes can be noticed.

  • Neuroblastoma can also cause bulging eyes. It is a cancer of the sympathetic nervous system.

  • Orbital cellulitis can also be a cause of bulging eyes. In this case, the tissue lining the eye socket will get infected. It is usually caused by bacteria and also fungus.

  • Sarcoidosis can also cause bulging eyes. Sarcoidosis is a condition in which tiny inflammatory cells grow in different parts of the body. The eyes are one of the commonly affected areas.

What Are the Signs and Symptoms of Bulging Eyes or Proptosis?

The following are the signs and symptoms of bulging eyes or proptosis.

  • The white part of the eye will be visible. Precisely, in a normal eye, only the colored part of the eye with a lower white part of the eye will be visible. In the case of bulging eyes, the upper white part of the eye will also be visible without even lifting the eyelid. This is a classic sign of a bulging eye.

  • One can see the eyeballs are placed so much in front of the eye socket.

  • Bulging eye conditions will present only in one eye and rarely both. In case of only one eye is affected, the condition can be easily evaluated with reference to the normal one.

  • There will not be any permanent vision loss. But one may experience double vision and blurred vision.

  • The bulging eyes can appear red, and it can be painful.

  • The affected eye will be sensitive to light (photosensitivity).

  • The affected eye can be hard to move due to muscle tightness.

  • Dry or watery eyes can be noticed.

  • Irritation of the eye and throbbing sensation.

  • In rare cases, due to the compression of the optic nerve, blindness may occur.

  • One may feel pressure behind the eye.

Who Is at Risk of Getting Affected by Bulging Eyes?

The ones who are affected by Grave’s disease and the ones having increased production of thyroid hormones (hyperthyroidism) are most likely to develop bulging eyes or proptosis.

How to Diagnose Bulging Eyes?

An ophthalmologist will require a detailed medical history of the patient to check if there are any underlying medical conditions that are causing bulging eyes.

Then a series of tests will be advised to diagnose the condition clearly, which are as follows:

  • The eye will be dilated with dilating eye drops to study the layers of the eye precisely.

  • A slit-lamp examination is the most common diagnostic procedure done to study the inner layers of the eye. Basically, this method will include a microscope fitted with a slit-lamp, used to study every layer of the eye precisely.

  • Tests will be carried out to assess eye movements.

  • Exophthalmometry is a test done to assess how far the eyeball has protruded from its original anatomical position.

  • Blood tests will be carried out to check the thyroid levels and to detect the presence of infections.

  • Magnetic resonance imaging (MRI) and computed tomography tests will be advised to check if any tumor or bleeding is present.

How to Manage Bulging Eyes?

  • Artificial eye drops will be prescribed to relieve dry eye conditions.

  • If the bulging eyes are caused by an infection, the appropriate antibiotics or other medications will be prescribed.

  • In case of inflammation is present, then appropriate corticosteroids will be prescribed.

  • In case hyperthyroidism is the causative factor, the appropriate treatment will be scheduled to correct the hyperthyroid condition.

  • If Grave’s disease is found to be the cause, then beta-blocker medications will be prescribed. In case of severe Grave’s disease, surgery will be planned to operate on the thyroid gland or remove the thyroid gland. In case it is going to be removed, thyroid hormone replacement therapy will be advised by the doctor.

Conclusion:

Bulging eyes can be a threatening condition to look at as such. It can be prevented by keeping the thyroid levels in check. Getting regular blood tests done to assess the thyroid levels and taking appropriate medications in case it is high will help. If an individual is undergoing treatment for bulging eyes, smoking has to be quitted, as it can interfere with the treatment process.

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Dr. Shachi Dwivedi
Dr. Shachi Dwivedi

Ophthalmology (Eye Care)

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