Written by: Dr. Stephanie Mulick, O.D.

I was so confused when someone told me they had a popped eye. What does that mean? I still don’t know but I can assume a couple of things. 

“My eye popped!” could it be Exophthalmos or Proptosis

Exophthalmos or Proptosis is a condition in which one or both eyes protrude from the orbit, giving an appearance of bulging eyes. 

The most common cause of bilateral exophthalmos is Grave’s disease. 

Grave’s Disease or Thyroid Eye Disease:

Grave’s disease is a condition that results in an over-active thyroid gland causing more thyroid hormone to be produced than what is needed (hyperthyroidism). The symptoms of hyperthyroidism can include weight loss, frequent bowel movements, trouble sleeping, heat intolerance and bulging eyes. It is more common in females than males and usually presents between the ages of 30-50. It is more likely to develop in people with a family history or those with an autoimmune disease. 

Work up/Examination

• History of thyroid disease
• Cigarette smoking: increases the risk for ocular symptoms
• Hertel Exophthalmometer: to measure the amount of proptosis
• Extraocular motility test: to determine if there is limited eye movement
• Complete health evaluation of the eyes including a dilated eye exam
• Thyroid blood tests: T3, T3RU, T4, and TSH
• CT scan
• Communication between Endocrinologist and Ophthalmologist for proper treatment

The following video is from Dr. Tayani a fellowship trained Oculoplastic surgeon.

https://youtu.be/hSi9L-Lmx_U

Several other conditions can cause Exophthalmos including:

• Cysts
• Trauma
• Hemorrhages
• Aneurysm
• Infection
• Neoplasm: mass or tumor
• Pseudotumor
• Sarcoidosis: an inflammatory condition which causes granulomas to build up in the body
• Increased intracranial pressure 

A Unilateral proptosis can be caused by an increase in the volume of the tissue behind one eye.

Conditions that can cause eyes to protrude forward:

Condition	Laterality  (unilateral or bilateral)	Age of Onset
Grave’s Disease	Usually Bilateral Rarely Unilateral	20-50 years old females more than males
Congenital Craniofacial synostosis	Bilateral	At Birth
Osteitis deformans   or Paget Disease	Bilateral	Over 55 years old  males more than females
Childhood Rickets	Bilateral	6-36 months old
Dermoid cyst	Unilateral	Birth to 5 years old
Non-traumatic Orbital hemorrhage (very rare)	Unilateral	20-78 years old
Tumors	Usually Unilateral/ rarely Bilateral	Varies depending on etiology
pseudotumor/Idiopathic intracranial hypertension	Unilateral	Most common in obese women age 11-58
Histiocytosis	Bilateral	1-15 years old
Traumatic aneurysm	Unilateral	Most common in females age 30-60
Amyloidosis	Bilateral and Unilateral	60-70 years old
Sarcoidosis	Usually Unilateral/ rarely Bilateral	Typically age 25-40, but sometimes older
Carotid-Cavernous Fistula: spontaneous (rare) and traumatic	Usually Unilateral/ rarely Bilateral	20 years old and up
Cavernous sinus thrombosis (extremely rare condition)	Unilateral	Most common in females under 50 years old

Conclusion:

I still don’t know exactly what “popped eye” means, but two conditions come to mind: 

1. Exophthalmos/Proptosis “bulging eye” which can be caused by several conditions, the most common of which is Grave’s disease. 
2. a subconjunctival hemorrhage or broken blood vessel of the eye is simply just a bruise of the eye requiring no treatment, review my post on subconjunctival hemorrhage for more information.