Big bulging eyes often grab more attention at the pretext of looking more beautiful. However, bulging eyes or eyes that project out of their normal position might not be a sign of beauty always but could be a serious medical condition.

One way to observe bulging is that in most normal cases, the white part of the eye will not be seen between the upper eyelid and iris. If the white area is visible in such a scenario, it could be a sign of abnormal bulging. Bulging eyes are also referred to as exophthalmos or proptosis by doctors. The bulging could either be bilateral or unilateral.

If one of the eyes has sudden bulging, it should immediately be given medical attention. Graves’ Eye disease can lead to bulging eyes, also known as thyroid eye disease. The body produces too much thyroid hormone and the immune system attacks the tissue around the eyes which makes the eyes protrude.

Other symptoms include:

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

Causes

Other possible causes of bulging eyes are:

Cancers like Neuroblastoma (a type of cancer that can affect your sympathetic nervous system), leukaemia (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 tumours from cancer elsewhere in the body. A tumour 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 or swelling in the eye socket and the eye protruding due to collection of blood behind it.
• Sarcoidosis and other connective tissue diseases.
• Certain infections can attack the eye and inflame the eye socket like orbital cellulitis.

If any unusual bulging is observed in either one, or both the eyes, you must visit an oculoplastic surgeon. The surgeon might 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

Treatment for bulging eyes depends on the underlying cause. Based on the diagnosis, the doctor is likely to prescribe the following:

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

In the case of Graves’ disease or a thyroid condition, the following is recommended by an 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.

(The author is consultant-oculoplasty, Sankara Eye Hospital)