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If Your Dog’s Eye Has Protruded — Proptosis First Aid and the Golden Hour

Eye HealthQ&AMeongsiljang Veterinary Advisory Board

Canine eye protrusion is an acute emergency. It’s essential to understand the breeds at risk, underlying causes, immediate first aid steps, and treatment options. We’ve compiled the key information every pet owner should know in a Q&A format.

Canine Eye Protrusion and Proptosis Are Acute Emergencies

A puppy with its eyeball protruding from the socket, while the veterinarian prepares for surgery.

Canine proptosis, or eye bulging, is a serious emergency in which the eyeball partially or completely protrudes from the eye socket (orbit). It is most commonly caused by trauma, such as collisions, car accidents, or fights with other dogs, and occurs most frequently in brachycephalic (short-nosed) breeds. - Causes of proptosis: Most cases result from trauma and are more likely to occur in breeds with shallow eye sockets and protruding eyes, such as brachycephalic dogs. Immediate veterinary care is essential. - When to seek emergency care: The sooner, the better. Studies show that the likelihood of vision recovery increases when treatment is prompt, the degree of eyeball displacement is minimal, and the pupillary light reflex (PLR) remains intact or the pupil is constricted. - What pet owners should do: Keep the eye surface from drying out by covering it with a clean cloth, but never try to push the eyeball back in with your hands. Eyeball repositioning must be performed under general anesthesia at a veterinary clinic, so transport your pet to the clinic immediately and follow the veterinarian’s instructions.

Why Does Proptosis Occur?

Canine proptosis, or proptosis, is primarily caused by trauma. Common incidents include collisions during play, car accidents, fights with other dogs, and falls. - Risk in brachycephalic breeds: These dogs have eyes positioned further forward and smaller eye sockets, making them highly vulnerable to impact. This susceptibility stems from their anatomical structure, with genetic factors also playing a role. - Weakened orbital support: The tissues surrounding the eye may be lax, making the eye more prone to protrusion. - Post-traumatic response: Impact can damage the tissues around the eye, causing it to bulge outward. - Importance of prevention: Using a leash and muzzle during outings is essential. Minimizing external stimuli and providing a safe environment are key to prevention.

Brachycephalic breeds have eyes that protrude forward, with shallow eye sockets.

What Are the Main Causes of Proptosis?

The primary cause of proptosis (eye bulging) in dogs is trauma. Common examples include collisions during play, car accidents, fights with other dogs, and falls. - Anatomical vulnerability in brachycephalic breeds: These breeds have eyes positioned more forward and smaller eye sockets, making them more susceptible to injury from impact. This is a genetic and structural trait, representing a biological limitation. - Weakening of tissues around the eye: The tissues that hold the eye in place may become weakened, increasing the risk of proptosis. - Effects of external stimuli: Sudden movements or impacts can exert direct pressure on the eyes. - Need for preventive care: It is essential to use a leash and muzzle when going outside and to ensure a safe play environment.

An animated diagram illustrating the mechanism of eye protrusion in brachycephalic dogs

Immediate Veterinary Visit Is Essential

The sooner treatment begins for a protruding eyeball, the higher the chance of preserving vision. Prognosis for vision recovery is generally better when the pupillary light reflex (PLR) is intact, the pupil is constricted, and there is minimal displacement of the eyeball. Conversely, the prognosis worsens if there are multiple extraocular muscle tears, corneal or scleral ruptures, or hyphema (bleeding in the anterior chamber). This condition cannot be managed at home, so immediate veterinary care is essential. Delays in treatment can lead to a poorer outcome.

Emergency Response Steps

If the eyeball is protruding, the first priority is to keep the surface of the eye from drying out. Cover the eye with a cloth dampened with clean water (sterile saline is even better) to prevent it from drying. - Never press or push the eye back in: Reduction of a prolapsed eyeball must be performed in a veterinary clinic under general anesthesia. Attempting to push it back manually can cause further tissue damage. - Safe transport: Keep the eye protected and transport your pet to the clinic as calmly and steadily as possible. - Follow your veterinarian’s instructions: Seek immediate examination upon arrival at the clinic. Your veterinarian will determine the appropriate course of treatment, such as whether to preserve the eye or perform an enucleation (surgical removal of the eyeball). - Your role as a caregiver: Quick decision-making and action are key to preserving vision. Prompt veterinary care is the most critical factor.

A pet owner gently covering their dog’s protruding eyes with a clean, damp cloth while transporting them to the veterinary clinic.

Proptosis Risk: Breed Comparison

Item	Risk Level	Characteristics
Poodle	Low	Non-brachycephalic, deep eye sockets making it less vulnerable to impact
Shih Tzu	High	Brachycephalic, most common predisposed breed, shallow eye sockets and protruding eyes
Pug	High	Brachycephalic, predisposed breed, forward-set eyes and shallow eye sockets
Lhasa Apso	High	Brachycephalic, predisposed breed, shallow eye sockets and protruding eyes

Proptosis is most common in brachycephalic breeds, occurring especially in Shih Tzus, Pugs, and Lhasa Apsos. This is because their eye sockets are shallow and their eyes protrude forward.

Treatment Options and Prognosis

Proptosis requires immediate surgery. The procedure involves moistening the ocular surface with a physiological solution, repositioning the eye under general anesthesia, and securing it in place for 10 to 14 days using temporary tarsorrhaphy. If eyelid swelling is severe, lateral canthotomy may be necessary. - Importance of surgical timing: The likelihood of vision recovery is higher when treatment is prompt, ocular displacement is minimal, and the pupillary light reflex remains intact. In cases of severe damage where the eye cannot be preserved, enucleation may be considered. - Post-operative care: Care is needed to protect the eye and prevent infection and corneal injury. - Factors affecting prognosis: Prognosis is known to worsen if there is rupture of the extraocular muscles, corneoscleral rupture, or hyphema. - Owner precautions: Regular check-ups and maintaining a safe environment are essential even after surgery.

A scene of surgery to return a puppy's eye back to its proper position

Prevention and Recurrence Prevention Are Key

Proptosis, or eye bulging, is most commonly caused by trauma, so environmental management to minimize accidents and collisions is paramount. Use a leash when going outside, ensure play areas are safe, and limit rough interactions with other dogs. Brachycephalic breeds are especially vulnerable because their eyes protrude forward, making them more susceptible to injury, so extra caution is essential. Prevention is key.

Reviewed by a veterinarian

Dr. Tony — Punnawat Phongkittirak

Veterinarian

A veterinarian who majored in veterinary medicine at Khon Kaen University, Thailand, and completed the IVSA program at North Carolina State University in the United States. Drawing on clinical experience at animal hospitals, he works in the pet healthcare field and is dedicated to building a digital care environment that connects pet parents with veterinarians.

Frequently Asked Questions

My pet’s eye is bulging out. What should I do at home?

Cover the eye with a cloth soaked in clean water (saline solution is even better) to prevent it from drying out, and never press or attempt to push the eye back into place. Since resetting a prolapsed eyeball requires general anesthesia at a veterinary clinic, please head to the hospital immediately.

Which breeds are most commonly affected by prolapse?

This condition is most commonly seen in brachycephalic breeds such as Shih Tzus, Pugs, and Lhasa Apsos, due to their forward-facing eyes and shallow eye sockets.

Can vision return after an eye has been displaced from its socket?

The sooner treatment begins, the less the eye has shifted from its socket, and the more the pupillary light reflex remains intact, the higher the likelihood of vision recovery. Conversely, the prognosis worsens if there are extraocular muscle tears, corneal or scleral ruptures, or anterior chamber hemorrhage.

Can it recur?

Proptosis is usually caused by trauma. While it doesn't necessarily mean the same eye will prolapse again, it's important to use a leash when going out and maintain a safe environment to minimize the risk of accidents.

Can a bulging eye heal without surgery?

Natural recovery without surgery is unlikely. The dislocated eyeball needs to be repositioned under general anesthesia and temporarily secured with sutures to keep the eyelids closed. The longer treatment is delayed, the worse the prognosis may become.