Endocrine Ophthalmopathy

An autoimmune disease of the tissues and muscles of the orbit, leading to the development of exophthalmos and a complex of ocular symptoms.

Pathogenesis. The disease is based on autoimmune disorders that lead to changes in extraocular muscles and retrobulbar tissue: disruption of the structure of muscle fibers, diffuse cellular infiltration of lymphocytes and plasma cells, accumulation of mucopolysaccharides, swelling of muscles and fiber, causing an increase in the volume of retrobulbar tissue, disruption of microcirculation with subsequent proliferation of connective tissue and the development of fibrosis.

Often combined with autoimmune thyroid diseases.

Symptoms Patients complain of lacrimation, especially in the wind, photophobia, a feeling of pressure in the eyes, double vision (especially when looking up and to the side), protrusion of the eyeballs.

On examination, pronounced exophthalmos is noted, often bilateral. Normally, with exophthalmometry, the protrusion of the eyeballs corresponds to 20 mm, the difference in the indicators of the left and right eyes does not exceed 1 mm. In patients, the height of the eyeballs may exceed these values ​​by 28 mm.

In the edematous form of the disease, pronounced swelling of the eyelids, conjunctiva, and injection of scleral vessels are noted. When extraocular muscles are predominantly involved in the pathological process, symptoms caused by their damage come to the fore: symptoms of Mobius, Graefe, Dalrymple, Stellwag, etc.; restriction of the mobility of the eyeballs up to their complete immobility.

Fundus: swelling of the retina, optic discs, optic nerve atrophy. Concentric narrowing of the visual fields and central scotomas are noted. Corneal ulceration, perforation, and infection may occur.

For diagnosis, ultrasound, computed tomography and magnetic resonance imaging of the retrobulbar space are of great importance, allowing one to determine the severity of damage and identify groups of affected extraocular muscles, and assessment of thyroid function.

Treatment. If the function of the thyroid gland is impaired, its correction is mandatory.

Glucocorticoids (prednisolone, starting from 30-40 mg/day orally; in case of contraindications from the gastrointestinal tract, corticosteroids are administered parenterally). Reducing swelling, exophthalmos, increasing the range of movement of the eyeballs, reducing discomfort in the eyes are indications for reducing the dose of glucocorticoids. Dehydration therapy (triampur, furosemide) is prescribed.

In severe cases, with severe swelling and no effect of corticosteroid therapy, X-ray therapy is applied to the orbital area. Drying of the cornea is prevented by gluing the eyelids or using protective films. Diet with limited salt and liquid.

In cases of severe disease, corrective surgery is performed on the orbital muscles and retrobulbar tissue.