Endocrine pathology and eye changes

With insufficient activity of parathyroid glands as a result of hypocalcemia, cataracts develop along with convulsions, tachycardia, and respiratory disorders. The turbidity of the lens during tetany can occur within a few hours. With biomicroscopy in the cortical layer of the lens, under the anterior and posterior capsules, dotted and dashed opacities of gray color are seen alternating with vacuoles and water slits, then the cataract progresses. It is removed surgically. Treatment of hypocalcaemia consists in the administration of parathyroid medications and calcium salts.

Patients with acromegaly on the basis of pituitary dysfunction develop retinal angiopathy, a symptom of a stagnant disc appears, central perception of color diminishes, and fields of vision drop out in a bitemporal fashion. The disease can end with atrophy of the optic nerves and complete blindness. Most often, the cause of the disease is the eosinophilic adenoma of the pituitary gland.

With hyperfunction of the cortex and adrenal medulla, developing hypertension causes changes in the retina that are characteristic of secondary arterial hypertension. With hypofunction (Addison's disease), electrolyte and carbohydrate metabolism is disrupted. The patient has no appetite, general weakness develops, body weight decreases, hypothermia, arterial hypotension and skin pigmentation, including eyelid skin and conjunctiva, are noted. In the case of a prolonged course of the disease, the color of the iris and the fundus becomes darker. Treatment is carried out by an endocrinologist.

Dysfunction of the thyroid gland causes changes in the orbital fiber and external eye muscles, which leads to the appearance of endocrine exophthalmos.

Diabetes mellitus develops in representatives of all human races. According to the world statistics, diabetes accounts for 1 to 15% of the total population of the world, and the incidence is constantly increasing. The focus of modern diabetologists is the problem of vascular complications of diabetes, on which the disease's prognosis, ability to work and the life expectancy of a patient depend. With diabetes, the vessels of the retina, kidneys, lower extremities, brain and heart are intensively affected. An ophthalmologist can be the first to detect changes in the eye that are characteristic of diabetes mellitus, when patients come with complaints about vision loss, vision of black spots and spots, without suspecting that they have diabetes. In addition to retinopathy, diabetes develops cataracts, secondary neovascular glaucoma, corneal damage in the form of point keratopathies, recurrent erosions, trophic ulcers, endothelial dystrophy, blepharitis, blepharoconjunctivitis, barley, iridocyclitis, and sometimes the oculomotor nerves are affected.

The first signs of changes in the fundus are the retinal veins, venous stasis, venous hyperemia. As the process progresses, the veins of the retina acquire a spindle shape, become convoluted, stretched - this is the stage of diabetic angiopathy. Further, the walls of the veins become thicker, there are parietal thrombi and foci of pereflebit. The most characteristic feature is the saccular aneurysmal enlargement of small veins scattered throughout the eye fundus, located in a paramacular manner. When ophthalmoscopy, they look like a cluster of individual red spots (they are confused with a hemorrhage), then the aneurysms turn into white foci containing lipids. The pathological process goes to the stage of diabetic retinopathy, which is characterized by the appearance of hemorrhage, from small to large, covering the entire eye fundus. They often occur in the area of the macula and around the optic disc. Hemorrhages appear not only in the retina, but also in the vitreous body. Preretinal hemorrhages are often precursors of proliferative changes.

The second characteristic sign of diabetic retinopathy is deep waxy and cottony whitish foci of exudation with vague boundaries. They occur more often when combined with diabetic retinopathy with hypertension or nephropathy. Waxy-like exudates have the form of droplets with a whitish hue.

Retinal edema and focal changes are often localized in the macular area, which leads to a decrease in visual acuity and the appearance of relative or absolute cattle in the field of vision. The lesion of the macula area in diabetes is called diabetic maculopathy, which can occur at any stage of the disease and manifests itself in exudative, edematous and ischemic (worst-case vision) forms.

To establish the correct diagnosis and solve the problem of laser coagulation of affected vessels fluorescent angiography helps. This is the most informative method that allows to determine the initial lesions of the vessel wall, their diameter, permeability, microaneurysms, capillary thrombosis, ischemia zones and blood circulation velocity.

The next stage in the development of pathological changes is proliferative diabetic retinopathy, in which proliferative changes in the retina and vitreous humor are added to the changes that appear in the stage of angiopathy and simple diabetic retinopathy. In this stage, a new formation of capillaries is observed, the loops of which appear on the surface of the retina, the optic nerve disk and along the vessels.

With the progression of the process, the capillaries grow into the vitreous with the hyaloid membrane detached. In parallel with neovascularization, there are fibrous growths localized preretinal and growing into the vitreous and retina. With ophthalmoscopy, proliferates look like grayish white stripes, foci of various shapes covering the retina.

The fibrovascular tissue penetrating the posterior hyaloid membrane of the vitreous humor gradually compacts and contracts, causing a retinal detachment. The proliferative form of diabetic retinopathy is distinguished by a special severity, rapid course, poor prognosis and usually manifests itself in young people.

The picture of the fundus in diabetes mellitus changes if it is combined with hypertensive disease, atherosclerosis, nephropathy. Pathological changes in these cases are growing faster.

Diabetic retinoangiopathy is considered benign if it flows in stages for 15-20 years.

Treatment pathogenetic, i.e. Regulation of carbohydrate, fat and protein metabolism, and symptomatic - elimination and prevention of manifestations and complications of diabetes mellitus.

For the resolution of hemorrhages in the vitreous body, enzyme preparations are effective: lidase, chi-motripsin, iodine in small doses. To improve oxidation-reduction processes, ATP is prescribed.

The most effective method for the treatment of diabetic retinopathy is laser coagulation of the retinal vessels, aimed at suppressing neovascularization, closing and delimiting vessels with increased permeability, and also preventing traction detachment of the retina. With different variants of diabetic pathology, special methods of laser treatment are used.

In the case of diabetic cataracts, surgical treatment is indicated. After the extraction of cataracts, complications often occur: hemorrhages in the anterior chamber of the eye, detachment of the choroid, etc.

In the presence of vitreous haemorrhages with a significant decrease in visual acuity, traction retina detachment, as well as fibrovascular proliferation, removal of the altered vitreous body (vitrectomy) with simultaneous endolaser coagulation of the retina is performed. In recent years, thanks to new technical equipment, vitreoretinal surgery has achieved great success. It became possible to excise the preretinal clefts closing the area of the yellow spot. Such operations return sight to patients who were previously considered incurable.

[1], [2], [3], [4]