Bulging Eyes: Causes, Diagnosis, & Treatments

Exophthalmos is the medical term for bulging eyes. It’s also sometimes called proptosis. In either case, these are descriptive terms for an abnormal eye symptom. In other words, they’re not eye diseases; they simply refer to symptoms typically caused by a systemic or local disease.  

Someone with bulging eyes has eyeballs that appear to protrude much further out from the eye socket than normal. 

The most common cause of bulging eyes is a thyroid condition called Graves’ disease. This is an autoimmune disease, meaning that the body attacks its own healthy cells for reasons not clearly understood. Some autoimmune diseases can be managed with medications, but none are curable. 

Other examples of autoimmune diseases include rheumatoid arthritis, psoriatic arthritis, Type I diabetes, lupus, and the unsightly but generally benign skin disease vitiligo. 

The eyeballs are set into the eye socket and held in place with muscles, fat cells, and other tissues. Any movement of these structures out of their normal place may cause the eyeball to bulge. 

Although some people may have slightly more bulging eyeballs than others, bulging eyes are generally defined as being able to see the white part of the eye over the top of the iris or the colored part of the eye. The cause is most likely thyroid disease, but there are other possibilities: 

• Glaucoma (a serious eye disease where too much pressure builds up within the eyeball)
• Leukemia (a type of blood cancer originating in the bone marrow)
• Cellulitis of the eye tissues or periorbital area (irritation or infection of the eye tissues)
• Rhabdomyosarcoma (a type of muscle cancer)
• Histiocytosis (the body has too many of a certain type of white cell)
• Neuroblastoma (a cancer of the nerves)
• Hemangioma (a usually benign condition seen mostly in small children where there is a local buildup of blood vessels visible on the skin’s surface)

It’s also possible for trauma or even eye surgery to cause bleeding within the eyeball. If severe enough, it could push the eyeball forward or otherwise out of place.  When an eyeball pops nearly or completely out of its socket, this is called globe luxation. 

More About Globe Luxation

Although rare, it’s possible for the eyeball to pop out of its socket entirely. This is a medical emergency, and immediate treatment is necessary to preserve vision in that eye. Globe luxation is mostly caused by some type of trauma, but it can be something as relatively minor as exhaling while holding the nostrils closed, violent sneezing, or improperly removing or inserting contact lenses. 

However, globe luxation is more likely to be caused by severe trauma, such as a sporting or auto accident involving a direct blow to the head or eye area. 

Thyroid eye disease may increase your chances of globe luxation. So can having shallow eye sockets in a condition called Crouzon syndrome and another condition called floppy eyelid syndrome.

Treatment for Globe Luxation

If no damage to the eye muscles or optic nerve has occurred, it may be possible for an eye doctor to gently push the eyeball back into place manually. If any injury to the eye structures is present, surgery will most likely be needed to repair the damage and protect and preserve vision. The bony socket surrounding the eye called the orbit may also be fractured and require surgical repair. 

Complications of Globe Luxation

Some people recover completely from globe luxation, but complications, such as a corneal abrasion, optic nerve damage, vision loss, exposure keratopathy (damage to the cornea), and secondary blepharospasm (severe eyelid twitching) are possible problems following an occurrence of globe luxation. 

Graves’ Disease

Most cases of eyeball protrusion are caused by thyroid problems. In the case of Graves’ disease, the body attacks healthy thyroid tissue and causes it to malfunction. This results in hyperthyroidism or an excess of thyroid hormones in the blood. 

Graves’ disease may also refer to TED or thyroid eye disease. 

A butterfly-shaped organ located in the frontal neck area, the thyroid works with the brain’s pituitary gland, sometimes called the master gland, to maintain blood levels of thyroid hormones in a delicate and precise balance.  

The pituitary monitors blood levels of the thyroid hormone thyroxine and signals the gland to produce more when blood levels begin to drop out of the normal range. It does this through a hormonal chemical messenger called TSH or thyroid-stimulating hormone. 

In Graves’ disease, the autoimmune attack causes the thyroid to overproduce thyroxine and other thyroid hormones. This produces symptoms such as:

• Sensitivity to light
• Swollen eyelids
• Bulging eyeballs
• Double vision
• Dry eye despite excess tear production
• The white part of the eye becoming red and irritated
• A sensation of grit or sand in the eye

It’s possible for TED to be so severe that the eyelids cannot close over the eyeball completely. When this occurs and is left untreated, damage to the eye and vision loss is possible. 

Treatment for Bulging Eyes

Specific treatment for exophthalmos depends on the cause. Your doctor will determine this and make a diagnosis by beginning with a medical history and asking questions about your symptoms. These may include:

• When did you first notice this bulging?
• Is it both eyes or just one?
• Is the problem getting worse, better, or staying the same?
• Do you have symptoms like dry eye, pain, vision loss, or excessive tearing?
• Do you have any hyperthyroidism symptoms like unexplained weight loss, diarrhea, feeling nervous, insomnia, anxiety, shaking, and increased appetite?

Your doctor will also measure your pulse and blood pressure, and because thyroid disease is the most likely cause, examine and palpate your neck around the area of the thyroid gland. Elevated blood pressure and pulse further suggest thyroid malfunction. 

Your doctor will examine your eyes for irritation and redness. If these are present, they are further clues pointing towards Graves’ disease. You will need blood tests to measure your thyroid hormone levels and possibly an ultrasound to rule out or confirm any tissue swelling.  

Your eye doctor may also use a special ruler-like instrument called an exophthalmometer to accurately measure and track the degree of your eye bulging. 

Other possible tests include a CT or computerized tomography to look for abnormalities in your eye socket and MRI or magnetic resonance imaging. Unlike an x-ray, which can only directly image bones and teeth, an MRI can identify sources of inflammation in the soft tissues, such as the thyroid gland. 

Since exophthalmos can prevent your eyelids from closing completely, you may need special lubricating drops to protect your cornea and other eye structures from damage. 

Other possible treatments includgl

• A recommendation to stop smoking. Bulging eyes are linked to cigarette smoke, so quitting this harmful habit is key. Smoking will also worsen certain symptoms of hyperthyroidism, such as high blood pressure and elevated pulse. Smoking is further linked to other serious eye diseases like cataracts and AMD or age-related macular degeneration. 
• Steroids, such as prednisone and dexamethasone, temporarily calm the body’s immune system to relieve swelling, pain, and inflammation. These drugs can have serious long-term side effects, so your doctor will likely look for better solutions for extended use. However, steroids are generally safe, well-tolerated, and highly effective when used in the short term for fast relief of symptoms. 
• Radiation or chemotherapy is used if cancer is the cause of thyroid malfunction. 
• Surgery may not always be necessary or even possible. Your doctor will determine if surgery is a good option for your case. 
• Antiviral and antibiotic drugs may be prescribed if a viral or bacterial infection is suspected or confirmed. 

When to See Your Eye Doctor

Bulging eyes may develop so slowly that you may not notice them for quite a while. Family members or friends may see the condition before you do. If any eye bulging is detected or eye pain, symptoms of hyperthyroidism, or vision changes are also present, it’s time to see an eye doctor. 

Top Eye Doctors Near You

If you’re concerned about bulging eyes or another eye problem, or you just need a routine eye exam and possibly new eyeglasses or contact lenses, we have the answer. 

We have compiled a list of top-rated eye care professionals practicing nationwide. One or more is likely to be near you. All of our doctors provide routine vision care as well as care for eye diseases like exophthalmos. We’ve made it easy to find a great eye doctor and set an appointment at your convenience. All our listed eye doctors warmly welcome new patients.