Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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New proptosis with threatened vision
Acute globe displacement with visual change, severe pain, restricted movement or systemic illness may reflect infection, haemorrhage, vascular disease or a rapidly expanding lesion.
Action: Arrange emergency ophthalmic assessment. A child with newly bulging eyes also needs immediate hospital assessment; do not wait for routine outpatient imaging.
Synopsis
Assess an eye that appears displaced, recognise urgent orbital disease and arrange an investigation pathway that protects vision while establishing the cause.
Proptosis describes globe displacement and does not identify its cause.
A painless orbital lesion can still be malignant.
Normal acuity does not exclude a developing compressive lesion.
Key red flags
Reduced acuity, colour desaturation, a field defect or a new pupil abnormality.
Investigation priorities
01
Documented ophthalmic examinationFirst step
Establish whether the eye or optic nerve is compromised.
Management branches
Emergency presentationPrioritise visual rescue and acute causes
New proptosis accompanies visual change, severe pain or systemic features.
Arrange emergency assessment and communicate the visual findings and progression directly.
Consider orbital infection, bleeding and vascular causes while the specialist evaluates possible tumour.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.
NHS bulging eyes guidanceReviewed June 2026; symptoms, broad causes and emergency advice including new proptosis in children.