Eyes are among the most distinct feature for not just humans but any creature. Eyes are also among the first features to be noticed when you meet someone or even when a baby is born. Big bulging eyes often receive more attention at the pretext of being more beautiful.

However, bulging eyes or eyes that project out of their normal position might not be a sign of beauty rather some serious medical condition. Some people are born with eyes that bulge out more than usual, while in some people bulging eyes grow due to an underlying medical condition.

One way to observe the bulging is that in most normal cases, the white part of the eye must not be seen between upper lid and iris. But if the white area is visible between the iris and the upper eyelid, then it could be a sign of abnormal bulging.

Bulging eyes are also referred to as exophthalmos by the doctors or proptosis. The bulging could either be bilateral or unilateral. If one of the eyes is suddenly observed bulging, it should immediately be given medical attention. Graves’ Eye disease can also lead to bulging eyes, also known as Thyroid eye disease. This is so because Graves’ disease occurs when the body produces too much thyroid hormone and the immune system attacks the tissue around the eyes which makes the eyes protrude forward.

Some other symptoms include:

• A gritty, dry sensation in the eyes
• Eye pain or pressure
• Puffy eyelids
• Inflaming or reddening of the eyes
• Sensitivity to light
• Vision loss or double vision
• Tearing / Watering
• Not being able to move both eyes in sync

Less commonly, Graves’ eye disease can occur in people with an underactive thyroid gland as well and rarely in people with normal thyroid levels.

Causes

Graves’ Disease is the most common cause of bulging eyes. Some other possible causes of bulging eyes are likely to be:

• Certain types of cancer like Neuroblastoma (a type of cancer that can affect your sympathetic nervous system), leukemia (a type of cancer that can affect your white blood cells), rhabdomyosarcoma (a type of cancer that can develop in your soft tissues) or metastatic tumors from cancer elsewhere in the body. A tumour (cancerous or non-cancerous) can develop behind the eye and push the eye forward
• Lymphoma, often non-Hodgkin’s lymphoma
• Hemangioma, an abnormal collection of blood vessels
• An injury leading to bleeding in the eye socket or swelling in the eye socket and the eye may protrude due to collection of blood behind it
• Sarcoidosis and other connective tissue diseases
• Certain infections can also attack the eye and inflame the eye socket like orbital cellulitis, an inflammation that can affect the tissues around your eye

If any unusual bulging is observed in either one or both of the eyes, you must ensure to get it checked with an Oculoplastic Surgeon. To diagnose the problem and the extent of it, the Oculoplastic Surgeon is likely to ask the patient to get one or more of the following tests done post a physical examination of the patient’s bulging eye/eyes:

• Vision test
• Dilated eye exam
• Slit-lamp exam
• Imaging tests like CT or MRI scans
• Blood tests

Treatment

The treatment plan for bulging eyes depends on the underlying cause that has led to the bulging of the eyes. Based on the diagnosis, the doctor is likely to prescribe one or more of the following:

• Eye drops
• Antibiotics
• Corticosteroids to ease inflammation
• Eye surgery
• Surgery, chemotherapy, or radiation to treat cancerous tumors

However, in the case of Graves’ disease or another thyroid condition, the following treatment is likely to be recommended by endocrinologist.

• Medications like beta-blockers or anti-thyroid medications
• Radioactive iodine
• Surgery to remove the thyroid gland
• Replacing the thyroid hormone if the thyroid gland has been destroyed

Contributed by Dr Shashidhar V S, Consultant-Oculoplasty, Sankara Eye Hospital