Bulging Eyes (Exophthalmos)

 Exophthalmos describes a condition where the eyeball protrudes from the eye socket, making it appear to bulge. It can affect one or both eyes and may occur due to a host of problems, the most common of which is tied to an overactive thyroid gland.


The main symptom of exophthalmos is an abnormal bulging of the eye. Additional signs and symptoms include:

  • Corneal dryness, pain, discomfort
  • Difficulty moving the eyes
  • Difficulty fully closing the eyes when sleeping or blinking.


One of the most common causes of exophthalmos is Graves’ disease, an autoimmune disease, more common in women than men, that causes the body to mistakenly attack the thyroid gland. This leads to an overactive thyroid gland or hyperthyroidism.

Due to hyperthyroidism, the tissues and muscles around the eyes become inflamed or swollen.  The combination of scarring and swelling in the eye muscles cause crowding of the eye socket, which pushes the eyes forward.

Other potential causes of exophthalmos include:

  • Eye trauma
  • Abnormally shaped blood vessels behind the eyes
  • Cancerous tumors
  • Infection of the eye socket
  • Bleeding within the eye


Exophthalmos is easily recognizable from the appearance of the eyeballs protruding from the sockets.

If the doctor suspects thyroid disease, a blood test to examine the function of the thyroid gland can be requested.  Additionally, eye tests can detect the ability of the patient to move the eyes. Also, the doctor will measure the degree of eyeball protrusion.

If the doctor suspects an abnormal growth behind the eyes, a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be required. These diagnostic scans allow the doctor to examine the eye socket in detail to detect tumor growth.


The longer the patient has untreated exophthalmos, the more severe it can get and the more difficult it is to treat. Hence, it’s crucial to seek medical help, so treatment can be started right away.

Hyperthyroidism – Hyperthyroidism might be treated with medication to normalize thyroid hormone levels.  This treatment won’t improve the eye problem, but it can help prevent the condition’s progression.

Swelling or Inflammation – Corticosteroids may be prescribed to treat severe cases of thyroid eye disease if the eyes are inflamed or painful.

Total Thyroidectomy – Complete removal of the entire thyroid gland prevents further progression of Graves’ eye disease and is an immediate cure.  For this reason, surgery is the preferred treatment for patients with Graves’ eye disease.  

Endoscopic Orbital Decompression – Another surgical procedure is performed if there is an impairment of visual acuity. The operation focuses on decompressing the orbit, aiming to increase its capacity.