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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
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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
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Ref: 2012F1271
© GOSH NHS Foundation Trust April 2012