Eyes Bulge (Exophthalmos)

What is exophthalmos?

Exophthalmos is a bulging forward of one or both eyes. In severe cases, the eyelids can no longer cover the entire front of the eye.

What is the cause?

Exophthalmos happens when the muscle and fat lining the eye socket swells. This can happen with Graves' disease, a thyroid disease that is the most common cause of exophthalmos.

A tumor or abnormal blood vessels behind the eye can also push the eye forward.

A bacterial infection in the eye socket may also cause the eye to bulge forward. If not treated quickly and properly, this infection can spread from the eye socket to the brain. This is an emergency. It may cause permanent loss of sight and can be life threatening.

What are the symptoms?

The symptoms include:

• eyeball bulging forward, showing more of the white of the eye than is normal (you appear to stare or look surprised all the time)
• limited eye movement
• blurred or double vision
• gritty, dry feeling in eye
• red, congested eyes
• in severe cases the eyelids cannot be closed completely

How is it diagnosed?

The eye care provider will do a complete eye exam. The provider may also measure how far your eye is bulging forward with an instrument called an exophthalmometer.

You may also be given:

• a blood test to check thyroid hormone levels
• an ultrasound test or a computerized scan (CT or MRI) of your eye sockets, to look for infection, a tumor, or other possible reasons for your eye to be pushed forward

How is it treated?

The treatment of exophthalmos depends on the cause.

If the cause is thyroid disease, your healthcare provider may suggest that you:

• Take anti-thyroid or steroid medicine.
• Have an operation on your thyroid gland. (This will not affect your eye disease and you may have to take thyroid hormones).
• Use a radioactive iodine drink to destroy most of the thyroid tissue.

If the exophthalmos persists or is caused by other disorders, your provider may suggest that you:

• Use eyedrops or ointment to keep the eye moistened.
• Wear prism glasses or have surgery on your eye muscles to correct double vision.
• Wear eye patches at night if the eyes don't close completely.
• Have radiation therapy or use steroids to decrease swelling behind the eye.
• Have surgery to relieve the pressure and the bulging eye caused by the soft tissue swelling. This may also help the eyelids close.
• Take antibiotics for infections.
• Have surgery to remove a tumor. In severe cases, the eye may need to be removed.

Eyelid surgery can be done to reduce the staring look and improve your appearance, regardless of the cause of your problem. This type of surgery is done only after other necessary eye bone or muscle surgery has been done.

How long will the effects last?

If thyroid disease is the cause and you are treated early, your vision and appearance may return to normal. However, in some cases, even after thyroid disease has been successfully treated, the bulging will not go away and may even get worse.

The effects may be long-term or permanent in very serious cases that are not treated early enough or are affected by other illnesses.

How can I take care of myself?

Follow any instructions your provider has given you, including taking any prescribed medicine. Make sure you take all the medicine you are prescribed, even if you start to feel better.

How can I help prevent exophthalmos?

There is no proven way to prevent any of the causes of exophthalmos.

Tell your provider if you notice any of these symptoms of thyroid disease:

• nervousness
• sleeplessness
• always feel warm or cold
• eating more, yet losing weight
• fast or irregular heartbeat
• blurring of your vision or double vision
• a bulging forward of one or both eyes
• irritation or swelling of your eyes

Regular health checkups and eye exams can help in early diagnosis and treatment.