Orbital Proptosis (Bulging Eye)

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Orbital proptosis is a condition that causes the eyes to bulge or protrude outward. When only one eye is bulging, it may be related to a growth within the orbit or adjacent sinuses such as a tumor or expansion of an obstructed sinus (mucocele). When both eyes are bulging, it is often caused by Grave’s disease, an autoimmune disorder affecting the thyroid gland that also enlarges the muscles that move the eyes.1

What Is Orbital Proptosis?

Orbital proptosis refers to the abnormal protrusion of one or both eyes in relation to the orbits (bony compartments that normally house the eyes and surrounding structures). While most cases of orbital proptosis are due to Grave’s disease (resulting in Grave’s Ophthalmopathy), the condition can also be caused by growths within the orbit or adjacent sinuses, trauma, infection, and bleeding or abnormal blood flow within the orbit.

Grave’s Disease is an auto-immune condition, where antibodies that normally protect someone from outside pathogens instead attack and trigger inflammation within normal tissues within the body. In Grave’s Disease, these antibodies attack the thyroid gland and tissues within the orbit, leading to overgrowth of muscles and fat cells and displacement of the eye(s) forward to protrude from the orbits. As the eyelids may not provide adequate closure the more forward the eyes are displaced, this can lead to excessive dryness of the eyes and cause corneal irritation, abrasions, vision loss, as well as an undesired cosmetic appearance.2

Orbital Proptosis Symptoms

Orbital proptosis symptoms may include:2

  • Sudden or progressive bulging or protrusion of the eye(s)
  • Double or blurred vision
  • Incomplete eyelid closure, particularly during sleep
  • Eye Irritation, redness, and discomfort
  • Excessive tear production

How Is Orbital Proptosis Diagnosed?

Bulging or enlargement of one or both eyes should be examined by a physician experienced with this condition as soon as possible. If left untreated, orbital proptosis can lead to partial or complete vision loss.3 The My Houston Surgeons team has highly skilled Board-Certified and Fellowship-trained ENT Surgeons with expertise in Rhinology, including the management of Orbital Proptosis. Initial workup includes CT and occasionally MRI imaging to determine the cause of the orbital proptosis, possible nasal endoscopy if a sinus or nasal lesion is suspected, bloodwork to determine the status of thyroid function and determine presence of auto-antibodies if Grave’s Disease is suspected, and surgical planning when indicated for decompression of the orbits. Ophthalmology evaluation is indicated for any patients with irritation, discomfort, or vision change as well.

Treating Orbital Proptosis

Asymptomatic orbital proptosis caused by Grave’s Disease may be monitored closely as the underlying condition is treated. However, any symptoms caused by orbital proptosis may be indications that surgical intervention should be performed to reduce the chances of vision loss. In addition, many other causes of orbital proptosis are themselves indications for surgical intervention, such as infection failing antibiotics or a growth within the orbit or sinuses.

A minimally invasive transnasal endoscopic approach can be performed in the majority of cases. This generally allows for removal or biopsy of growths, drainage of infections, and partial removal of the bony orbital walls (orbital decompression) to allow displacement of orbital contents into the sinuses and decrease the orbital proptosis. Endoscopic approaches avoid visible scars, and are highly successful thanks to the excellent visualization provided by modern video equipment.

Contact My Houston Surgeons For Bulging Eye Treatment

The team at My Houston Surgeons is dedicated to helping patients find relief from symptoms associated with orbital proptosis. We create customized treatment plans designed for the unique needs of each patient. Contact us to schedule your appointment today.

Trused Source Icon - Checkbox Sources

1 Eye (Lond). Which factors are associated with quality of life in patients with Graves’ orbitopathy presenting for orbital decompression surgery? Available: https://pubmed.ncbi.nlm.nih.gov/25998940/. Accessed July 18, 2022.

2 Cleveland Clinic. Bulging Eyes (Proptosis). Available: https://my.clevelandclinic.org/health/diseases/21537-bulging-eye. Accessed July 18, 2022.

3 Intern Med Rev (Wash D C). Etiologies of Proptosis: A review. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204542/. Accessed July 18, 2022.

The Doctors at My Houston Surgeons have either authored or reviewed and approved this content. Page last updated:

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