Formula Medical Group
Apple Valley, CA
760-242-1234


James Krider, MD


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Bulging eyes - exophthalmos

What are bulging eyes?

Bulging eyes, known medically as exopthalmos, is a condition characterized by abnormal protrusion of the eyeballs. This protrusion exposes areas of the eyeball above and below the iris (the colored part of the eye) and forces the lids apart, sometimes to such a degree that it is impossible to close the eyes. Eye movements also become restricted, causing a peculiar, unblinking stare. When a person with bulging eyes looks down, the upper lid does not follow the motion of the eye smoothly, but instead makes a number of jerky, stepwise movements.

SYMPTOMS

  • One or both eyeballs that protrude.
  • Eyelids that don't close.
  • Fixed stare.
  • Restricted eye movements.
  • Dryness and gritty feeling in the eye.

One or both eyes may be affected, and the condition is usually more pronounced on one side than on the other. Some disorders, such as tumors, tend to affect only one eye. Others, including thyroid disease, generally cause both eyeballs to protrude.

In the worst instances, the eyeball may protrude as far as one-half to three-quarters of an inch from its normal position. The eye can become excessively dry, and its blood supply may be interrupted. Complications include drying of the cornea, corneal ulcers, and infection. The condition can cause double or blurred vision, and in severe cases, it can lead to blindness.

What causes bulging eyes?

Most often, the condition is caused by any disorder that results in excessive production of thyroid hormones, such as Graves' disease.

Other causes include inflammation and swelling of tissues lining the orbit in which the eyeball lies, eye cancer, an aneurysm (an abnormal widening of the artery behind the eye), congenital abnormalities (such as congenital glaucoma, which leads to enlargement of the eyeball), and trauma, which can lead to formation of an arteriovenous fistula (an abnormal passage between an artery and a vein). Injury or infection can trigger the formation of thrombi (blood clots) in the veins that drain the orbit and face, which can also lead to bulging eyes.

How are bulging eyes diagnosed and treated?

Diagnosis is based on examination of the eyes and

In extreme cases, the eyes may protrude so much that it's impossible to close them. This can result in dry, irritated eyes and an increased risk of infection.

In extreme cases, the eyes may protrude so much that it's impossible to close them. This can result in dry, irritated eyes and an increased risk of infection.

tests to uncover the underlying cause. Since an overactive thyroid is often at fault, its function is measured first. X-ray examination of the orbit may be helpful, as may a CT (computed tomography) scan of the head. If the x-ray or physical examination reveals a growth, exploratory surgery may be necessary to establish the diagnosis.

When an aneurysm or an arteriovenous fistula causes bulging eyes, the condition is accompanied by characteristic pulsation that can be detected with a stethoscope placed on the closed lids or against the temple.

Treatment of bulging eyes depends on the underlying disease. Medication or (in extreme cases) partial destruction of the thyroid gland with radiation can control excessive production of thyroid hormones. If these approaches fail to relieve the bulging, surgery may be necessary. Surgery may also be performed to remove an eye tumor or repair an aneurysm.

In the case of trauma, cold compresses are applied to the eye for 24 hours, followed by warm compresses and antibiotics to prevent infection. When swelling subsides, an operation may be required.

Steroid drugs can reduce swelling in the orbit, and protective creams may relieve eye dryness. If the eyelids do not close, it is sometimes necessary to suture together the outer edges of the upper and lower lids.

What can I do myself?
You may have to wear dark glasses or an eye shield or take care to protect the eye from becoming too dry.

When should I see my doctor?
See a doctor as soon as you notice that your eyes appear to be pushed forward or if they are unusually sensitive.

Dry, burning eyes and light sensitivity may develop before you become aware that your eyeballs are protruding. Symptoms of an underlying disorder, such as the weight loss and jitteriness that accompany Graves' disease, should also prompt you to see your doctor.

What will the doctor do?
The doctor will assess the degree of bulging by examining your eyes with a device called an exophthalmometer. During this examination, you will be asked to look down and to the sides. The doctor will also take blood samples to measure the level of thyroid hormones in your system and, if necessary, order an x-ray or a more precise imaging study, such as a CT scan. Depending on the cause of the condition, he or she will prescribe appropriate treatment.

The course of bulging eyes

Bleeding or inflammation can cause the eyeballs to protrude suddenly. When other causes are involved, the condition develops more slowly. Chronic inflammation of the orbit may not produce symptoms for 2 or 3 weeks; a brain or eye tumor takes longer. In conditions that produce hyperthyroidism, bulging eyes also develop gradually over several weeks.

The outcome depends on the underlying cause. Correction of a thyroid abnormality may cause bulging eyes to improve, although the condition may persist. The earlier treatment is undertaken, the better the chances of a cure.

Are bulging eyes dangerous?
They can lead to impairment of vision or blindness. If the bulging is due to an eye or brain tumor, the underlying cause can be life threatening. Untreated thyroid disease also has serious consequences.

What can I do to avoid bulging eyes?

No measures can be taken to avoid this condition.

This article was last reviewed November 21, 2005 by Dr. James Krider.
Reproduced in part with permission of Home Health Handbook.
A-V fistula
Aneurysm
Blood clots
Bulging eyes
Cellulitis, orbital
Glaucoma, congenital
Graves' disease
Thyroid, overactive


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