Causes of Bulging Eyes (Exophthalmos)

What Does Bulging Eyes (Exophthalmos) Indicate?

Exophthalmus or bulging eyes is most commonly a symptom of a thyroid disorder called Grave's disease, but may have other causes as well.
Exophthalmus or bulging eyes is most commonly a symptom of a thyroid disorder called Grave's disease, but may have other causes as well.

The medical term for bulging eyes is exophthalmos. It is not a condition in itself, but a symptom of other conditions. 

What Are Symptoms of Bulging Eyes (Exophthalmos)?

Bulging eyes (exophthalmos) are a symptom of other conditions. Depending on the cause, symptoms that may accompany bulging eyes may include:

  • Eye pain
  • Changes in visual clarity or sharpness 
  • Double vision
  • Decreased fields of vision
  • Temporary vision loss or blackout periods
  • Foreign body sensation 
  • Dry, gritty eyes 
  • Eye redness
  • Puffy eyes
  • Eye inflammation and swelling 
  • Sensitivity to light (photosensitivity) 
  • Tearing

What Causes Bulging Eyes (Exophthalmos)?

Causes of bulging eyes (exophthalmos) can include: 

  • Inflammatory
    • Thyroid orbitopathy (Graves’ disease), the most common cause
    • Orbital inflammatory syndrome (orbital pseudotumor, benign orbital inflammation)
    • Erdheim-Chester disease
  • Vascular
  • Infectious
  • Endocrine
  • Cancerous (both benign and malignant)
    • Lacrimal
    • Meningioma
    • Lymphoma
    • Leukemia
    • Rhabdomyosarcoma
    • Retinoblastoma
    • Capillary hemangioma
    • Glioma 
    • Ossifying fibroma 
    • Dermoid cyst
    • Hand-Schüller-Christian disease
    • Metastatic disease (breast in women, lung and prostate in men, as well as gastrointestinal and kidney)
  • Traumatic
    • Orbital emphysema
    • Carotid-cavernous fistula
    • Traumatic or iatrogenic orbital hemorrhage
    • Orbital fractures
    • Facial fractures
  • Other
    • Craniosynostosis
    • Pfeiffer syndrome
    • Apert syndrome
    • Crouzon syndrome
    • Carpenter syndrome

How Is Bulging Eyes (Exophthalmos) Diagnosed?

The cause of bulging eyes (exophthalmos) is diagnosed with a history and physical exam, and the following tests: 

What Is the Treatment for Bulging Eyes (Exophthalmos)?

Treatment for bulging eyes (exophthalmos) depends on the cause and is aimed at reversing the problem and minimizing damage to the eye. 

  • Teprotumumab (Tepezza) is used to treat thyroid eye disease in adults
  • Ophthalmic lubricants are used to prevent complications from dry eyes
    • Artificial tears (Celluvisc, Murine, Refresh, Tears Naturale)
    • Polyethylene glycol 400/propylene glycol ophthalmic (Systane Balance, Systane Ultra, Tears Naturale Free, Hypo Tears, Murine Tears)
    • Carboxymethylcellulose ophthalmic (Refresh Optive Gel Drops, TheraTears Nighttime Dry Eye Therapy)
    • Hypromellose/carboxymethylcellulose ophthalmic (Genteal Lubricant Eye Drops, Moderate-to-Severe)
  • Sunglasses to ease light sensitivity
  • Corticosteroids
  • Stop smoking
  • Radiotherapy for the active stage of thyroid eye disease
  • Chemotherapy for cancerous causes
  • Antibiotics for infectious causes
  • Surgery in severe cases 
    • Orbital decompression surgery, in which a small amount of bone is removed from 1 or both eye sockets 
    • Eyelid surgery to improve the position, closure, or appearance of the eyelids 
    • Eye muscle surgery to bring the eyes into alignment and reduce double vision 

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