What is Proptosis?
If your eye bulges outward, you may have an eye problem called proptosis. Although the condition is often related to thyroid disease, it can have other causes. If you are diagnosed with proptosis, your ophthalmologist will offer treatments that will help you protect your eye.
What Causes Proptosis?
Proptosis can be caused by eye injuries, cancerous tumors, bleeding in the eye socket, eye infections, inflammation, or abnormal blood vessels behind the eyes. A thyroid problem called Grave's disease is the most common cause of the condition, according to the Merck Manual.
Grave's disease is an autoimmune disorder that occurs when the thyroid gland becomes more active than usual and produces too much thyroid hormone. If you have Grave's disease, you may notice some of these symptoms:
- Shaky hands
- Trouble tolerating hot temperatures
- Unintended weight loss
- Racing heartbeat
- Weak muscles
- Shaking hands
- Difficulty sleeping
- Thick, red skin on the shins or tops of the feet
How Does Grave's Disease Affect the Eyes?
About a third of people who have Grave's disease also develop eye symptoms, according to the American Thyroid Association. In addition to bulging eyes, symptoms may include:
- Eye pain or pressure
- Puffy or retracted eyelids
- A gritty feeling in the eyes
- Dry eye
- Difficulty closing your eyes
- Sensitivity to light
- Trouble moving the eyes
- Vision loss
How is Proptosis Treated?
Proptosis can make your eyes feel uncomfortable and may even threaten your ability to see. If you can't close your eyes completely, they may become too dry. When your eyes are dry, you're more likely to develop sores on your cornea, the clear layer of tissue that covers the iris and pupil. These sores can be very painful and could scar the cornea, causing permanent vision damage.
Fortunately, visiting your ophthalmologist when you first notice changes in your eye can help you avoid vision loss. At your appointment, you'll discuss your symptoms and review your medical history, including eye infections and injuries.
Your ophthalmologist might order a computerized tomography (CT) or magnetic resonance imaging (MRI) scan to determine why your eye or eyes are bulging, in addition to a blood test to check your thyroid hormone level.
Since many people diagnosed with proptosis have Grave's disease, your ophthalmologist will want to know if you have any of the common symptoms of the disease. If your eye doctor suspects that Grave's disease is the cause, they will refer you to an endocrinologist, a doctor who specializes in treating disorders that affect the glands that produce hormones. You'll see both doctors during your treatment.
Your treatment will depend on the cause. If you have an infection, antibiotics will be prescribed, while surgery may be needed if you have a tumor. Keeping your thyroid hormones under control will be helpful if you have Grave's disease. Your endocrinologist may prescribe medications that lower the production of the hormones, recommend radiation therapy to shrink the gland, or suggest surgery to remove it.
Although the treatments will help ease your Grave's disease symptoms, you may still have some eye symptoms. Your ophthalmologist can recommend treatments and strategies that will help, including:
- Eye drops or liquid tears to keep your eyes moist
- Special eyeglass lenses called prisms that reduce double vision
- Taping your eyelids to keep your eyes moist while you sleep
- Corticosteroid injections to decrease pain and inflammation
- Tepezza, an intravenous (IV) medication that reduces inflammation and may help with double vision and bulging
- Surgery to enhance the way your eyes look
Are you concerned about a bulging eye? Contact our office as soon as possible to schedule an appointment.
American Academy of Ophthalmology: New Disease Treats Thyroid Disease without Surgery, 2/5/20
Merck Manual: Proptosis, 5/21
Loyola University Medical Center: Proptosis (Bulging Eye)
American Thyroid Association: Graves’ Disease