Bulging Eyes- What Are My Options?
- Asked by simply_jai in Atlanta, GA
- 2 years ago
I have fairly big, bulging eyes. My doctor thought it was because of a thyroid problem but after running test, it turns out that my thyroid is normal. Considering that I don't have a thyroid problem, what can I do to make my eyes appear "deep set" and not as bulgy?
The situation is more complex than just testing the thyroid.
Graves' disease is an autoimmune disease that affects the thyroid simulating the thyroid gland. For whatever reason it also causes inflammation of the orbits and a prominent eye is a sign. It is possible to have Grave's disease with a perfectly normal thyroid function. This is called euthyroid Graves' disease. For this reason, it is highly appropriate for you to be assessed by an oculoplastic surgeon to get to the bottom of what is causing your issues and how best to approach the issue. The American Society for Ophthalmic Plastic and Reconstructive Surgeons maintains a website (asoprs.org) which has a geographic directory to help you find a well qualified surgeon. I would recommend that you see a university based surgeon.
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There is help for bulging eyes
Some patients with rather severe bulging of the eyes have thyroid eye disease. This can happen even when blood tests for hyperthyroidism are normal. About 6% of the time, patients with thyroid eye disease (Graves orbitopathy) never do show any endocrine abnormalities. These patients are said to have "euthyroid" Graves disease.
An experienced oculoplastic surgeon can help you understand the full range of treatment options. In many patients, the first surgical step (after any endocrine abnormalities are straightened out and the eyes are stable for 6 months) is orbital decompression. In this surgery, bone or fat is removed to give your eyes more space in the orbits. This allows the eyes to settle back into the sockets. Many patients will subsequently have surgery on their eyelids to allow more natural coverage of the eyeballs. This is called eyelid retraction surgery.
ASOPRS.com will show you a listing of surgeons in your area who are likely to have the most experience with this type of problem.
Mark Lucarelli, MD, FACS
I would agree with the other surgeons on this forum. Euthyroid Graves Disease occurs in 5-10% of patients with this problem. Your oculoplastic surgeon or primary care doctor may want to draw labs for thyroid autoantibodies, which are often present in patients with Graves disease, even if the thyroid levels are normal. Best of luck, Gary Lelli
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Even though your thyroid tests may be normal, your prominent eyes (proptosis) could still be related to thyroid disease, aka "Euthyroid eye disease". It may also be related to your general eye, orbit, facial anatomy. If it is stable, then surgery could be considered. The first best option would be orbital decompression, to set the eye back. Then eyelid surgery may be needed. Consult an oculoplatic surgeon (through ASOPRS).
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Yes, IMHO, your eyes are bulging quite a bit and you should have a thorough medical and eye workup with an opyhalmologist.
Web reference: http://www.drfpalmer.com
You need to see an oculoplastic surgeon for an evaluation. I recommend finding a member of the American Society of Ophthlamic Plastic and Reconstructive Surgery (ASOPRS) on the ASOPRS website.
Sometimes we see bulging eyes due to thyroid eye disease, as your doctor mentioned. Sometimes thyroid eye disease can manifest before abnormalities in your thyroid hormone levels can be detected. Of course, there are other conditions that can cause the appearance of bulging eyes. An oculoplastic surgeon can examine you and order studies to determine the cause of your bulging eyes. Once the cause is determined, treatment options can be offered.
You may benefit from several procedures, including:
1) Orbital decompression surgery to bring the eyes back in the eye sockets.
2) Eyelid surgery to bring the eyelids closer together.
3) Cheek implants to augment your cheeks.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.