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Great Ormond Street Hospital for Children NHS Foundation Trust: Information for Families Protruding eyes This information sheet from Great Ormond Street Hospital explains the causes, symptoms and treatment of protruding eyes and where to get help. Protruding eyes occur when the tissue behind the eyeball swells, pushing it forwards and exposing more of the white. It is also known as exophthalmos (when both eyes are protruding) or proptosis which can be bilateral (both eyes) or unilateral (one eye). In children protruding eyes are uncommon and can be caused by various things. What causes protruding eyes? Protruding eyes may be congenital (present from birth) or acquired. The most common cause of congenital protruding eyes is shallow orbits (the bony part of the skull that houses the eyeballs). Though rare in children, thyroid problems can cause bilateral (both eyes) acquired protruding eyes. Other causes of protruding eyes (both or just one) are tumours behind the eye(s). What are the signs and symptoms of protruding eyes? When the eyes are in their usual position, the white is not visible between the top Sheet 1 of 2 Ref: 2012F1271 and/or bottom of the iris and the eyelid. However, as soon as the eyes start to protrude, white will appear at the top and/or bottom of the eye. As well as a clear change in the visual appearance of the eyes, they may also become dry and itchy, or stiff and painful to move (although this is rare). How are protruding eyes normally diagnosed? A child’s doctor will be able to rule out any more common causes of eye irritation, for example hay fever or conjunctivitis. They will refer the child to an ophthalmologist (eye specialist) who will carry out: a blood test – to check for the presence (and quantities) of hormones that could indicate a problem with the thyroid gland a CT or MRI scan - to look for abnormalities in the construction or positioning of the eye socket, or for unusual swellings behind the eye/s. If a thyroid problem is detected, the child will then be referred to an endocrinologist (a hormone specialist). © GOSH NHS Foundation Trust April 2012 How are protruding eyes normally treated? Treatment will depend on what is causing the eyes to protrude. Regardless of the cause, the most important thing to do is to protect the eyes. If eyes are protruding, the lids often don’t completely close at night, resulting in drying of the eyes. This can lead to an infection of the cornea and an ulcer. Lubricating eye ointment must be given at night or whenever the child sleeps. In addition regular artificial tears may be needed. What happens next? Unfortunately, even after treatment, the eyes may not return to normal. Notes Compiled by the GOSH web team Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH www.gosh.nhs.uk Sheet 2 of 2 Ref: 2012F1271 © GOSH NHS Foundation Trust April 2012