What does it mean if your eyes start to bulge?

Q: My 50-year old son has developed bulging eyes over the last few months. It makes him look different. What causes this? He takes a lot of vitamins; could this be the problem?

A: Your son's appearance could be the result of a condition called exophthalmos, an abnormal bulging out of one or both eyes. The other term doctors use to describe the same problem is proptosis. Some experts have defined the terms differently, but most of us use them interchangeably.

Sometimes eyes can appear to be bulging when a person has lost a lot of weight. The eyes remain the same, but the fat and muscle around the face is diminished. This makes the eyes look like they bulge in comparison.

I am always concerned when I hear that someone takes a lot of vitamins, especially if they're taking them instead of eating a well-balanced diet. However, it's very unlikely that the vitamins are directly causing hour son's "bulging eyes."

The most common cause of true exophthalmos is Graves' disease. Graves' disease is an autoimmune disorder. For unknown reasons, the body begins producing proteins called thyroid stimulating proteins that cause the thyroid gland to become overactive.

The disease also can cause proteins to accumulate in certain tissues, most commonly in the muscles that control eye movements. These muscles are called the extraocular muscles. They enlarge and push the eyes forward. Usually both eyes are affected.

Almost all people with Graves' eye disease have symptoms of an overactive thyroid including anxiety, tremor, difficulty sleeping, weight loss despite an excellent appetite and intolerance of heat.

Another rare cause of exophthalmos is glaucoma that occurs in early childhood. Because the eye is fully developed in adults, the much more common adult onset glaucoma doesn't make eyes bulge.

Most other causes of proptosis involve only one eye. Causes include:



--Bleeding behind the eye

--A blood clot behind the eye

--A tumor

Your son should make an appointment with his doctor and will probably need to see an eye specialist if he truly has exophthalmos.

(Howard LeWine, M.D. is a practicing internist and Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School.)

(For additional consumer health information, please visit www.health.harvard.edu.)


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