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Eyes - bulging

Protruding eyes; Exophthalmos; Proptosis; Bulging eyes

 

Bulging eyes is the abnormal protrusion (bulging out) of one or both eyeballs.

Considerations

 

Prominent eyes may be a family trait. But prominent eyes are not the same as bulging eyes. Bulging eyes should be checked by a health care provider right away.

Bulging of one eye, especially in a child, is a very serious sign. It should be checked right away.

Hyperthyroidism (particularly Graves disease) is the most common cause of bulging eyes. With this condition, the eyes do not blink often and seem to have a staring quality.

Normally, there should be no visible white between the top of the iris (the colored part of the eye) and the upper eyelid. Seeing white in this area most often is a sign that the eye is bulging.

Because eye changes develop slowly, family members may not notice it until the condition is fairly advanced. Photos often draw attention to the bulging when it may have gone unnoticed before.

 

Causes

 

Causes may include:

  • Glaucoma
  • Graves disease
  • Hemangioma
  • Histiocytosis
  • Hyperthyroidism
  • Hyperthyroidism caused by medications for other conditions
  • Leukemia
  • Neuroblastoma
  • Orbital cellulitis or periorbital cellulitis
  • Rhabdomyosarcoma

 

Home Care

 

The cause needs to be treated by a health care provider. Because bulging eyes can cause a person to be self-conscious, emotional support is important.

 

When to Contact a Medical Professional

 

Call your health care provider if:

  • You have bulging eyes and the cause has not yet been diagnosed.
  • Bulging eyes are accompanied by other symptoms.

 

What to Expect at Your Office Visit

 

The provider will ask about your medical history and do a physical exam.

Some questions you may be asked include:

  • Are both eyes bulging?
  • When did you first notice bulging eyes?
  • Is it getting worse?
  • What other symptoms do you have?

A slit-lamp examination may be done. Blood testing for thyroid disease may be done.

Treatments depend on the cause. Artificial tears may be given to lubricate the eye.

 

 

References

Clemmons DR. Approach to the patient with endocrine disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 228.

Yanoff M, Cameron D. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 431.

 
  • Graves' disease

    Graves' disease - illustration

    Graves disease is an autoimmune disorder that involves overactivity of the thyroid gland (hyperthyroidism). Hallmarks of the condition are bulging eyes (exophthalmos), heat intolerance, increased energy, difficulty sleeping, diarrhea, and anxiety.

    Graves' disease

    illustration

  • Hyperthyroidism

    Hyperthyroidism - illustration

    A goiter is a swelling in the neck due to an enlarged thyroid gland. The size may range from a single small nodule to a large neck lump. The swollen thyroid can put pressure on the windpipe and esophagus which can cause a cough, wheezing, breathing difficulties or swallowing difficulties. A goiter only needs to be treated if it is causing symptoms.

    Hyperthyroidism

    illustration

  • Periorbital cellulitis

    Periorbital cellulitis - illustration

    Periorbital cellulitis is an acute infection of the tissues surrounding the eye, which may progress to orbital cellulitis with protrusion of the eyeball. Complications include meningitis.

    Periorbital cellulitis

    illustration

    • Graves' disease

      Graves' disease - illustration

      Graves disease is an autoimmune disorder that involves overactivity of the thyroid gland (hyperthyroidism). Hallmarks of the condition are bulging eyes (exophthalmos), heat intolerance, increased energy, difficulty sleeping, diarrhea, and anxiety.

      Graves' disease

      illustration

    • Hyperthyroidism

      Hyperthyroidism - illustration

      A goiter is a swelling in the neck due to an enlarged thyroid gland. The size may range from a single small nodule to a large neck lump. The swollen thyroid can put pressure on the windpipe and esophagus which can cause a cough, wheezing, breathing difficulties or swallowing difficulties. A goiter only needs to be treated if it is causing symptoms.

      Hyperthyroidism

      illustration

    • Periorbital cellulitis

      Periorbital cellulitis - illustration

      Periorbital cellulitis is an acute infection of the tissues surrounding the eye, which may progress to orbital cellulitis with protrusion of the eyeball. Complications include meningitis.

      Periorbital cellulitis

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Eyes - bulging

           

             

            Review Date: 1/31/2015

            Reviewed By: Linda J. Vorvick, MD, medical director and director of didactic curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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