Bulging eyes: Description
The protrusion of the eyes – popularly known as “googly eyes” – is called exophthalmos or protrusio bulbi (bulging of the eyeball) by physicians.
There is normally enough room in the eye socket of the skull, the orbit, to accommodate the eyeball along with muscles, nerves and fat padding. However, the bony cavity does not allow for further increases in size. Therefore, if the existing tissue swells as a result of inflammation or disease, the eyeball can only move outward.
This has not only aesthetic consequences – most of the time other serious complaints result from the “buggy eyes”:
- Due to the imperfect closure of the eyelids, the eye (especially the cornea) dries out (xerophthalmia).
- Eye inflammations and tears of the cornea are common.
- Visual disturbances in the form of double vision (diplopia) may result from deformation of the eyeball, stretching of the eye muscles, or damage to the optic nerve.
The “goggle eyes” can occur unilaterally or bilaterally, depending on the cause. In systemic diseases (i.e., diseases that affect an entire organ system or the entire body), both eyeballs usually protrude. If, on the other hand, only one side exhibits exophthalmos, this may be a sign of a tumor, inflammation or injury.
Puffy eyes: Causes and possible diseases
Endocrine Orbitopathy
Endocrine (metabolic) orbitopathy is also called endocrine exophthalmos. It is an immunologically induced inflammation of the contents of the orbit. Symptoms include unilateral or bilateral exophthalmos (unilateral or bilateral), disturbances in the motility of the eyeballs (with seeing double images), and characteristic eyelid changes.
In the vast majority of cases, endocrine orbitopathy occurs in the context of Graves’ disease. This is an autoimmune disease of the thyroid gland, which is associated with hyperthyroidism and occurs more frequently in women than in men. Typical for the disease is the combined occurrence of three symptoms ( called “Merseburg Triad”): Puffy eyes, enlarged thyroid gland (goiter or goiter) and palpitations (tachycardia).
It is not yet fully understood why the eyes become bulging in Graves’ disease. It is likely that the autoimmune processes (attacks of the immune system against the body’s own structures) lead to inflammation and enlargement of the fat pad behind the eyeball and the eye muscles.
Also rarely, endocrine orbitopathy occurs as an independent disease.
Eye inflammations
Various inflammations in the eye area can also be the cause of “googly eyes.”
- Orbitaphlegmone: This bacterial inflammation of the orbit is usually the result of sinusitis. It must be treated as soon as possible, because within a few hours the optic nerve can be completely destroyed. Symptoms of orbital naphlegmon are limited mobility of the eye, severe pain, visual disturbances, swelling of the eye, exophthalmos, fever and feeling of illness.
- Pseudotumor orbitae: A non-bacterial inflammation of unknown cause affects tissue in the orbit and causes symptoms such as unilateral exophthalmos, pain and visual disturbances.
- Granulomatosis with polyangiitis: This very rare rheumatic disease was formerly called Wegener’s disease. It is a chronic inflammatory vascular disease that can affect the eyes as well as other organs. This can manifest itself, among other things, with “googly eyes” and visual disturbances.
Orbital tumors
- Meningioma (meningioma): This is a usually benign brain tumor that, depending on its location, can also press on the eye and cause glaucoma.
- Cavernoma (cavernous hemangioma): This is a benign vascular malformation that can, in principle, develop anew in any organ – including the eye socket. The thin-walled vessels of a cavernoma pose a risk of bleeding.
- Neurofibroma: This is a benign tumor that arises from supporting cells of the peripheral nervous tissue (Schwann cells). It can form in the orbit and other areas, but most commonly occurs in the skin.
- Metastases: Daughter tumors of cancerous tumors can also occur in the eye and then lead to “googly eyes.”
- Hand-Schüller-Christian disease: This is an outdated name for a manifestation of Langerhans cell histiocytosis – a rare disease of unknown cause in which there is a proliferation of certain immune cells (granulocytes). The disease mainly affects children and is usually benign, but can also be malignant. The classic symptom is “goggle eyes”, rarely there are visual disturbances or strabismus. In addition to exophthalmos, chronic ear infections are often observed.
Other causes
- other trauma: blows to the eye from falls or fisticuffs can lead to fracture of the bony orbit and “goggle eyes”. A common sign of such a rupture is a “monocular hematoma” (“spectacle hematoma”), in which one or both eyes are surrounded by a circular bruise. This is significantly larger than a normal “black eye”. Visual disturbances also usually occur. Affected persons should seek medical attention as soon as possible!
- (Iatrogenic) retrobulbar hemorrhage: During eye surgery, patients are usually injected with a local anesthetic at the edge of the eye socket. This can lead to bleeding behind the eyeball (retrobulbar hemorrhage) with the formation of an exophthalmos.
Glubrous eyes: when do you need to see a doctor?
The protrusion of one or both eyes from the orbit is always a reason to see a doctor – whether an exophthalmos develops slowly over time (as in Graves’ disease) or occurs acutely after a blow to the eye or other injury to the face. In the second case, a doctor should even be consulted as soon as possible. Possibly, hemorrhages behind the eyeball or fractures of the bony eye socket are the reason for the “glubschauauge”. If the optic nerve was injured or constricted, blindness is imminent.
Glube eyes: What does the doctor do?
This is followed by a detailed examination of the eyes. Among other things, an exophthalmometer is used. This allows the doctor to measure how much an eye protrudes. Values of 20 millimeters or more or a lateral difference of more than two millimeters are considered pathological changes.
Measurement with the exophthalmometer is also very suitable for monitoring the progress of endocrine exophthalmos.
In addition, other ophthalmological examinations are performed, such as an eye test, determination of the visual field and examination of the fundus of the eye. During these examinations, the physician also looks for typical features of endocrine orbitopathy. One of these is the Dalrymple sign: When looking straight ahead, a narrow strip of the white of the eye (sclera) is visible between the edge of the upper eyelid and the upper edge of the cornea.
Blood tests can clarify the suspicion of a thyroid dysfunction as the cause of the “glazed eyes”. The various thyroid values in particular provide information here. Altered inflammatory parameters in the blood can indicate inflammatory processes. Whether bacteria are behind such inflammations and which ones exactly can be determined with a smear test.
Exophthalmos – Therapy
The therapy of exophthalmos depends on the underlying cause. For example, thyroid-related metabolic disorders are often treated with medication, even though this does not improve exophthalmos in many cases. In this case, it is important to take measures that help against eye complaints and prevent further damage to the eyes. These may include eye drops and medications that prevent drying of the eyes and improve motility.
In the case of a bacterial infection, the doctor usually prescribes antibiotics.
In some cases, surgery may be necessary, such as in Graves’ disease that does not respond to medication, or if a tumor is the cause of “goggle eyes.”
The treatment of exophthalmos or the underlying disease often requires the interaction of different specialists such as ophthalmologist, neurologist, otolaryngologist, internist and/or oral and maxillofacial surgeon. In addition, psychotherapeutic care can be useful if affected persons suffer psychologically very much from the “glubschauaugen”.
Glubschauugen: What you can do yourself
Protruding eyes always belong in medical care. Your own possibilities to actively fight against existing “glubschauugen” or to prevent exophthalmos are limited:
- It is very important to keep the cornea of the eye moist (e.g. with eye drops). This can prevent inflammation, ulceration and injuries or tears in the cornea.
- Regular testing of thyroid levels can quickly reveal abnormal changes, allowing for early treatment.
- If you have a predisposition to Graves’ disease, you should avoid risk factors that may be involved in disease onset. These include stress and smoking.
- If you have poor vision, regular visits to your eye doctor are advisable. Changes in vision and the eyeball can be detected at an early stage. Also, in case of sudden onset of visual disturbances, double vision or diminished vision, you should definitely consult an ophthalmologist immediately!
