She found that her right eye was bigger than her left eye two years ago, and because she was nearsighted and wore glasses, she didn’t pay attention to it. 1 year ago, she found that her right eye was bigger, and although it didn’t affect her ability to see, she went to the local hospital for aesthetic reasons. The ophthalmologist at the local hospital thought that the enlarged eye was caused by myopia and that there was no special treatment. Ms. Shen felt that this statement was not credible and chose to visit another tertiary care hospital. After examination, the ophthalmologist of this hospital found that the optic nerve of Ms. Shen’s right eye was pale in color and thought that there was a possibility of glaucoma, which was investigated and medication was administered. However, Ms. Shen’s right eye enlargement symptoms remained unresolved. In order to further clarify the diagnosis and treatment, Ms. Shen came to the ophthalmology department of Southwest Hospital for consultation with an orbital specialist, and was examined and found to have a possible intraorbital occupying lesion. In order to further confirm the inference, an orbital CT examination was performed and a mass-like object was found in the posterior segment of Ms. Shen’s orbit. After magnetic resonance examination, the initial diagnosis was intraorbital cavernous hemangioma in the right eye, which was surgically removed in its entirety. After surgery, Ms. Shen’s right eye regained its original appearance and no longer differed from her left eye. Patient’s question: Do you need to check the protruding eye without any symptoms? Doctor: A protruding eye is a clear sign of a lesion and the cause must be investigated in the hospital. In particular, if the protruding eyeball appears within a short period of time, accompanied by symptoms such as loss of vision and severe pain, acute malignant lesions should be highly suspected and the cause should be investigated at the hospital as soon as possible. The insidious painless protrusion is often ignored by patients and misdiagnosed or missed by some inexperienced clinicians. However, orbital protrusion is often indicative of a more difficult disease in the orbit, so patients with orbital protrusion need to go to the orbital disease unit of the ophthalmology department to confirm the cause of the protrusion to avoid delaying treatment. The protrusion of the eyeball is a common sign of orbital disease. When the volume of the orbital disease increases, the eye is driven forward due to the restriction of the surrounding bony wall, resulting in anterior protrusion or displacement of the eye to one side. If the difference between the two eyes is greater than 2 mm, or if the protrusion of the eye is increasing during observation, the possibility of orbital disease should be considered. Patient question: Why does ocular protrusion occur? Doctor: There are many reasons for protruding eyeballs, but the following are common causes of protruding eyeballs: tumors cause protruding eyeballs. Most of the orbital tumors originate in the orbit, and a few of them spread from the nearby paranasal sinuses, and rarely from systemic metastases. Endocrine ocular protrusion. The most common causes of ocular protrusion are classified as thyrotropic ophthalmoplegia and thyrotropic ophthalmoplegia. The former is caused by hyperthyroidism, while the latter refers to the protrusion of the eye due to excessive secretion of thyrotropin by the pituitary gland. Inflammatory ophthalmoplegia. One type is caused by acute inflammation of the orbit, such as orbital fasciitis, orbital cellulitis, and cavernous sinus thrombophlebitis. The other is caused by chronic inflammation of the orbit, such as inflammatory pseudotumor. Intermittent eye protrusion. This type of eye protrusion now occurs when the head is lowered and the breath is held with force, or when the jugular vein is compressed, and is mostly seen in patients with orbital varices. Pulsatile ophthalmoplegia. It is commonly caused by rupture of the internal carotid artery that communicates with the cavernous sinus due to traumatic skull base fracture, carotid atherosclerosis, aneurysm, and other factors. Traumatic ocular protrusion. Commonly caused by intraorbital hemorrhage or orbital emphysema after trauma. Protrusion of the eye due to congenital factors. The concomitant symptoms usually differ significantly between different causes of ocular protrusion. Common concomitant symptoms include pain, tearing, eye redness, double vision, decreased visual acuity, eye pulsation, increased intraocular pressure, and eyelid swelling. Different concomitant symptoms suggest different etiologies, such as pain, tearing, double vision, and eyelid swelling, which are most often seen in endocrine and inflammatory ocular proptosis. Of these, visual ghosting can be seen on almost all causes of ocular proptosis, as long as the proptosis and ocular motility disorders reach a certain level. Painless occult proptosis is often seen in ophthalmoplegia due to benign tumors. Decreased visual acuity is most often indicative of an intraorbital lesion that has involved the optic nerve. Patient’s question: Do I have to have surgery to treat a herniated eye? Doctor: There are many causes of protruding eyeballs, and the targeted treatment for different causes is completely different. For example, the tumor in the orbit of Ms. Shen is mostly solved by surgery, while the protruding eyeball caused by endocrine elements may be relieved by medication. The key aspect of orbital protrusion treatment is diagnosis. Orbital disease has complex etiology and often cannot be examined visually, so the diagnosis relies more on imaging. Adjunctive examinations can provide a lot of valuable information for different etiologies. For example, in endocrine orbital proptosis, thyroid function tests can help confirm the diagnosis; in inflammatory orbital proptosis, blood tests can provide a diagnostic basis; in orbital hemangioma patients, ultrasound is often needed to understand blood flow; in pulsatile orbital proptosis, a vascular murmur is often present in the orbital region, and a stethoscope can be useful at this time. After the initial diagnosis, targeted treatment can only be performed. Treatment is divided into surgical and non-surgical treatments. For orbital tumors, intraorbital hematomas, and endocrine proptosis that have caused severe IOP and optic nerve damage, surgical treatment is needed to remove the cause and lower the intraorbital pressure to relieve the condition; for general endocrine proptosis and inflammatory proptosis, more non-surgical treatment is needed.