Causes of Bulging Eyes (Exophthalmos)

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

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
  • Orbital arteriovenous malformation (AVM) varices (carotid-cavernous sinus fistula, arteriovenous malformation)
  • Orbital varix (venous malformation)
  • Aneurysms
  • Wegener granulomatosis
  • Churg-Strauss syndrome
• Infectious
  • Orbital cellulitis 
  • Subperiosteal abscesses
  • Mucormycosis
  • Concurrent sinus disease
• Endocrine
  • Cushing syndrome
• 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

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

• Measurement of the degree of eye protrusion with an exophthalmometer
• Blood tests
  • Complete blood count (CBC) 
  • Thyroid function studies
• Nasal cultures
• Imaging studies
  • Computerized tomography (CT) 
  • X-rays 
  • Magnetic resonance imaging (MRI) 
  • Ultrasound 
• Bone marrow biopsy 

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