ORBITAL PROPTOSIS (BULGING EYE)
Orbital proptosis, also known as exophthalmos, is a condition characterized by the bulging of one or both eyes. Orbital proptosis of both eyes is often the result of an autoimmune condition called Grave’s disease that affects the thyroid gland and can also cause eyes to bulge outward.1 The bulging of a single eye may be the result of an orbital tumor.
DIAGNOSIS OF ORBITAL PROPTOSIS
Given the serious nature of possible underlying causes of orbital proptosis, any enlargement or bulging of the eye(s) should be addressed as soon as possible by an experienced medical professional. Orbital proptosis can also cause vision loss if left untreated. At Houston Advanced Nose and Sinus, Dr. Arjuna Kuperan is a board certified Otolaryngologist (ENT) and a specialist in skull base disorders. He has the expertise to diagnose and treat orbital proptosis.
UNDERSTANDING BULGING EYES AND ORBITAL PROPTOSIS
The two major causes of orbital proptosis are orbital tumors and Grave’s disease. Orbital tumors generally only cause one eye to appear enlarged or proptotic. In rare cases, orbital proptosis may be caused by a severe sinus infection or trauma to the eye.
Patients with Grave’s disease are typically under the care of an endocrinologist to manage their hyperthyroidism. In this autoimmune disease, antibodies attack the thyroid gland and in some cases the fat surrounding the eyeball, which can make the eye appear to protrude out of the eye socket. This is called Grave’s orbitopathy and it usually affects both eyes. In addition to the unwanted appearance it creates, Grave’s orbitopathy can also lead to corneal irritation and abrasions and other vision problems because the eyelid is unable to cover the enlarged bulging eye completely.
SYMPTOMS OF ORBITAL PROPTOSIS
Concerning symptoms associated with orbital proptosis include:2
- Protrusion or bulging of either one or both eyes creating an abnormal appearance
- Double vision
- Difficulty or inability to completely close one or both eyelids
- Excessive irritation or scratchy feeling on the surface of the eye with redness or excessive tearing
TREATING ORBITAL PROPTOSIS (BULGING EYE)
In your initial appointment, Dr. Kuperan will assess your condition and review your medical history. He may use laboratory testing to check for elevated thyroid antibody levels and a nasal endoscopy (looking inside the nose with a small camera) to determine if a sinus tumor is invading into the orbit. An MRI of the orbit can be performed to determine if there is a tumor mass in the orbital cavity causing the proptosis. Successful treatment of orbital proptosis depends on choosing an approach tailored to the severity and cause of each case.
For orbital neoplasms that are medial to the optic nerve we can safely perform transnasal minimally invasive endoscopic orbital tumor resection. There are no visible scars since this approach is performed through the nose.
For orbital proptosis due to Grave’s disease we can perform minimally invasive transnasal endoscopic medial orbital decompression surgery. This approach is done through the nose without any visible scars or incisions and it allows the excessive orbital fat to reposition and significantly decreases the protrusion of the eye.
1 Wickwar S, Mcbain HB, Ezra DG, Hirani SP, Rose GE, Newman SP. Which factors are associated with quality of life in patients with Graves’ orbitopathy presenting for orbital decompression surgery?. Eye (Lond). 2015;29(7):951-7. doi: 10.1038/eye.2015.76
2 Dsouza S, Kandula P, Kamath G, Kamath M. Clinical Profile of Unilateral Proptosis in a Tertiary Care Centre. J Ophthalmol. 2017;2017:8546458. doi: 10.1155/2017/8546458
Dr. Arjuna Kuerpan has either authored or reviewed and approved this content.