What are bulging eyes?
Bulging eyes occur when one or both eyeballs protrude abnormally from the eye socket. Some people have eyes that appear more prominent than usual. This can be a normal trait when other family members share it. Bulging eyes are not normal. They are an indication that something is pushing the eyeballs outward. Other names for bulging eyes include proptosis and exophthalmos.
With a normal facial appearance, you usually cannot see any white sclera above clear cornea (the area above the iris, the color part of the eye). When eyeballs are bulging, white sclera is visible between the cornea and the upper eyelid. This change can affect one or both eyes and may begin suddenly or develop gradually over time. It can give people the appearance of constant staring or surprise. Other symptoms can occur with bulging eyes, depending on the cause. This includes dry eyes, red eyes, double vision, and vision changes.
Bulging eyes from thyroid disease, specifically Graves’ disease, is the most common cause of acquired proptosis in adults. Bulging eyes in Graves’ disease is called thyroid eye disease, or Graves’ ophthalmopathy. In children, the most common cause is orbital cellulitis. This is a serious infection of the tissues around and behind the eye.
Seek prompt medical care if you notice bulging eyes developing. Seek immediate medical care (call 911) for sudden onset of bulging eyes, bulging eye in a baby or child, or bulging eyes with the following warning signs:
Double vision or a loss or reduction in vision
Fever or headache
Pulsating sensation behind the eye
What causes bulging eyes?
In adults, the most common cause of bulging eyes is Graves’ disease. Graves’ disease is an autoimmune disease that causes hyperthyroidism—or overactive thyroid. About 50% of people with Graves’ disease have bulging eyes and other eye symptoms. This is known as Graves’ ophthalmopathy (thyroid eye disease). It occurs as the result of autoimmune-induced swelling of the tissues around and behind the eyes.
In children, the most common cause of bulging eyes is orbital cellulitis. This is typically a bacterial infection that spreads to the tissues around the eye from a sinus or dental infection. It can lead to blindness and requires prompt antibiotic treatment and possible surgery.
Other causes of bulging eyes
Bulging eyes may arise from less common conditions including:
Bleeding into the surrounding tissues
Blood vessel malformations
Glaucoma, including primary infantile glaucoma that is present at birth
Leukemia and histiocytosis, which is a white blood cell disorder
Orbital pseudotumor, which inflammation of the tissues around the eye without an infection
Tumors, including neuroblastoma
Some of these causes of bulging eyes may be serious or life-threatening.
What other symptoms might occur with bulging eyes?
Depending on the underlying cause, other symptoms can occur with bulging eyes.
Eye-related symptoms that may occur along with bulging eyes
Bulging eyes may accompany other symptoms that affect the eyes and vision including:
Inability to close eyelids completely
Irritated, watery eyes or a gritty sensation in the eyes
Limited eye motion
Red, swollen eyelids
Vision problems or sensitivity to light
Other symptoms that may occur along with bulging eyes
Several other symptoms can occur along with bulging eyes including:
Anxiety or irritability
Increased appetite, unintended weight loss, or diarrhea
Intolerance to heat or sweating
Sinus pain or pressure
Symptoms that might indicate a life-threatening or serious condition
In some cases, bulging eyes may occur with other symptoms that might indicate a serious or life-threatening condition. Seek immediate medical care (call 911) for bulging eyes with any of these potentially serious symptoms including:
Eye pain, pain around the eyes, or pain with eye movement
Pulsation behind the eyes
Seeing double, blurry vision, or vision loss
In addition, a bulging eye or eyes in an infant or child requires immediate evaluation in an emergency setting.
When should you see a doctor for bulging eyes?
Make an appointment to see your doctor if you notice bulging eyes without other serious symptoms.
Call 911 or go to your nearest emergency room for bulging eyes when:
You also have a fever or headache.
You feel pulsations behind your eyes or have vision changes, double vision, or sensitivity to light.
You have bulging of only one eye.
You have eye pain, pain around the eyes, or pain when you move your eyes in any direction.
You notice bulging eyes in an infant or child.
How is the cause of bulging eyes diagnosed?
To diagnose the cause of bulging eyes, your doctor will take a medical history, perform an exam, and possibly order testing. Questions your doctor may ask about your symptoms and medical history include:
Have you noticed bulging in both eyes or only one?
Is the bulging getting worse over time?
How long have your eyes been bulging?
Are you experiencing any other eye symptoms, such as pain, dryness, or vision changes?
Are you experiencing symptoms outside your eyes, such as weight loss or increased appetite?
What, if anything, seems to make your symptoms better or worse?
Do you have a family history of thyroid disease?
What other medical conditions do you have?
What medications do you take?
The exam may include a slit-lamp examination of your eyes. This involves using a special instrument to provide the clinician with a magnified view of the eyes. You may need to move your eyes in different directions while your doctor examines them. Your doctor may also feel your neck to check the size of your thyroid gland.
Tests your doctor may order include blood tests to check thyroid hormone levels. If only one eye is bulging, your doctor may order imaging exams, such as CT (computed tomography) and MRI (magnetic resonance imaging).
It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.
What are the treatments for bulging eyes?
Treatment for bulging eyes depends on the underlying condition. For orbital cellulitis, doctors prescribe antibiotics to treat the bacterial infection.
For thyroid eye disease, it is important to treat the underlying thyroid disorder. But this will not necessarily improve the eye bulging and other eye symptoms.
For mild symptoms, the following treatments may provide relief:
Applying cool compresses
Sleeping with your head elevated to decrease swelling
Taking a selenium supplement as recommended by your doctor
Using lubricating eye drops to moisturize and protect the cornea—the clear covering on the front of the eye
Using ointment, eye pads, or tape to keep eyes closed and moisturized during sleep
Wearing prism glasses to compensate for double vision
Wearing sunglasses for light sensitivity
For moderate to severe eye disease, other treatments may be necessary including:
Corticosteroids, either orally or intravenously
Immunosuppressants, such as rituximab (Rituxan), mycophenolate (CellCept), and teprotumumab (Tepezza)
External radiation to the eye tissues may be a last resort. This approach can take time to work, has not demonstrated conclusive long-term benefits, and may damage the retina.
Surgery may be necessary in some cases. Thyroid eye disease can take several months up to a couple of years to stabilize.
What are the potential complications of bulging eyes?
Because bulging eyes can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow your treatment plan. This will help reduce the risk of potential complications.
Complications of bulging eyes vary with the underlying cause. Possible complications include:
Corneal erosion and ulceration from the eyeballs protruding so far that the eyelids cannot completely close. This causes dryness and damage to the cornea.
Swelling and scarring of the tissue around the eye, which can change the way the eyes move and their appearance. Gaze limitation may also cause double vision.
- Vision loss, which may be permanent