Bulging Eyes

We have all seen people whose eyes seem to pop out at us. When prominent eyes are present since birth, they are usually a benign family trait. But if your eyes start to bulge later on, a condition called EXOPHTHALMOS (sometimes spelled exophthalmus) or PROPTOSIS, it can be a serious sign of Hyperthyroidism, an overactive thyroid. Bulging eyes are one of the most common signs of Grave's Disease, the leading form of hyperthyroidism.

Grave's Disease is an autoimmune disease in which antibodies attack the thyroid gland, causing it to produce an excess amount of thyroid hormone and a person's metabolism to speed up, sometimes to dangerous levels.

The excess hormones also can cause muscles, tissue, and fat in and around the eyes to swell and push the eye forward, resulting in bulging eyes, known as Grave's Ophthalmopathy or Thyroid Eye Disease. About half the people with Grave's Disease also have Thyroid Eye Disease. In fact, in some people, the eye signs are apparent before the other common signs of Grave's Disease, which include palpitations, hand tremors, insomnia, heat intolerance, and excessive hunger, thirst, and weight loss. Grave's Disease is about eight times more common in women than men, and women are few times more likely to have thyroid-related exophthalmos than men.

If you are not sure if your eyes or someone else's are bulging or just prominent, look closely at the whites of the eyes (sclera). In most people, including those with prominent eyes, you cannot see the whites showing between the tops of the irises and the upper eyelids. However, in people with exophthalmos, the whites if the eyes above or below the irises are very noticeable. People with Thyroid Eye Disease also have difficulty blinking, making them look like they are staring.

Eyes that do not blink enough may not produce enough tears, causing them to feel dry, gritty, and irritated. In some cases, completely closing the eyes becomes difficult, making them vulnerable to serious injury, including Corneal Ulceration (an open sore on the cornea) and possibly perforation. Finally, if the eyes cannot fully close at night, sleeping becomes extremely difficult.

If your bulging eyes are not caused by thyroid disease, they may be a  sign of an infection or glaucoma, or something even more serious, such as leukemia or an eye tumor. Treating the underlying thyroid or other condition often will help the eyes recede back to normal. But sometimes people are left with permanently bulging eyes. In very severe cases of exophthalmos, surgery may be needed to decompress the eyeball.

Exophthamos usually affects both eyes. If it suddenly occurs in only one, it can be the sign of a hemorrhage or serious inflammation in the eye socket (orbit) or sinus passage.