Endocrine ophthalmopathy

Thyrotoxicosis (Graves disease) is an autoimmune disease, which usually begins in 3 and 4 decades of life, among the sick predominate women. Thyroid disease (endocrine ophthalmopathy) of the eye can occur without clinical and biochemical signs of thyroid dysfunction.

More often there are systemic manifestations, but their severity does not correlate with ophthalmic symptoms. Graves disease without symptoms of hyperthyroidism is called ocular or euthyroid Graves disease. Ophthalmologists often face this form of the disease.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12],

Endocrine ophthalmopathy - What's going on?

The pathogenesis of endocrine ophthalmopathy includes an organ-specific immune response in which the humoral agent (IgG antibody) causes the following changes.

Thickened extraocular muscles with thyroid eye disease on the axial projection of CT

1. Inflammatory process in extraocular muscles. It is characterized by polymorphic cell infiltration in combination with increased secretion of glucosaminoglycates and osmotic accumulation of water. Muscles thicken sometimes to a size 8 times normal, and can squeeze the optic nerve. Subsequent degenerative changes in the muscles lead, ultimately, to fibrotic changes in them, limited mobility and restrictive ophthalmopathy and diplopia.
2. Inflammatory cell infiltration by lymphocytes, plasma cells, macrophages and mast cells of interstitial tissues, fatty tissue and lacrimal glands with accumulation of glucosaminoglycans and fluid retention. This leads to an increase in the volume of the contents of the orbit and a secondary increase in intraorbital pressure, which in itself can contribute to the further accumulation of fluid in the orbit.

[13], [14], [15], [16], [17], [18], [19]

Symptoms of endocrine ophthalmopathy

Endocrine ophthalmopathy can precede, coincide in time or appear after thyroidism and does not correlate with the degree of thyroid dysfunction. The range of manifestations is very wide: from minor signs to complete loss of vision due to exposure keratopathy or optical neuropathy. There are 5 main clinical manifestations of endocrine ophthalmopathy:

1. soft tissue damage,
2. retraction of the century,
3. exophthalmos,
4. optic neuropathy,
5. restrictive myoia.

Define the 2 stages of the disease.

1. The stage of edema (inflammatory), the manifestations of which are redness of the eyes and painful sensations. Lasts for 3 years and only 10% of cases lead to the development of persistent eye disorders.
2. The stage of fibrosis, in which eyeballs look calm, but painless motor disorders remain.

Soft tissue injury

Clinical Features

1. Symptoms: a sense of foreign body, photophobia, lacrimation and a feeling of discomfort.
2. Symptoms
   • swelling of the eyelid and periorbital area due to edema and infiltration of tissues behind the tarzo-orbital fascia, which can be accompanied by prolapse of fatty tissue in the eyelids;
   • hyperemia of the conjunctiva and epicleras is a subtle sign of the severity of the inflammatory reaction. Local hyperemia may correspond to the attachment zone of the horizontal muscle tendon to the sclera;
   • Chemosis is a manifestation of conjunctival edema and a semilunar fold. Light chemosis looks like a small fold of the excess conjunctiva, bending over the edge of the lower eyelid. With pronounced chemosis, the conjunctiva swells between the eyelids;
   • Upper limbal keratoconjunctivitis;
   • dry keratoconjunctivitis due to infiltration of lacrimal glands.

Treatment of endocrine ophthalmopathy

1. Moisturizers are topical for topolimbal keratoconjunctivitis, non-closure of eyelids and dryness.
2. The head should be raised during sleep with cushions to reduce periorbital edema.
3. Adhesion of the eyelids during sleep can facilitate the development of exposure keratopathy.