Endocrine ophthalmopathy

Endocrine ophthalmopathy is an autoimmune disease of the tissues and muscles of the orbit, leading to the development of exophthalmos and a complex of eye symptoms.

Pathogenesis. At the heart of the disease are autoimmune disorders that lead to changes in extraocular muscles and retrobulbar fiber: a violation of the structure of muscle fibers, diffuse cellular infiltration of lymphocytes and plasma cells, accumulation of mucopolysaccharides, edema of muscles and cellulose, which causes an increase in the volume of retrobulbar tissues, a violation of micro-circulation followed by overgrowth Connective tissue and the development of fibrosis. It is often combined with autoimmune diseases of the thyroid gland.

Symptoms. Patients complain of lacrimation, especially in the wind, photophobia, a feeling of pressure in the eyes, doubling (especially when looking up and sideways), protrusion of eyeballs. Examination revealed pronounced exophthalmos, more often bilateral. Normally, with exophthalmometry, the protrusion of the eyeballs corresponds to 15-18 mm. In patients, the distance of eyeballs may exceed these indices by 2-8 mm. With edematous form of the disease marked pronounced swelling of the eyelids, conjunctiva, injection of vessels sclera. With the primary involvement of the extraocular muscles in the pathological process, the symptoms caused by their defeat come to the fore: the symptoms of Moebius, Gref, Dalrymple, Shtelwag, and others; The limitation of the mobility of eyeballs up to their complete immobility. The ocular fundus: edema of the retina, optic discs, atrophy of the optic nerves. There is a concentric narrowing of the visual fields, the central scotoma. There may be ulceration of the cornea, its perforation, attachment of infection. For the diagnosis, ultrasound examination of the retrobulbar space, which allows one to determine the severity of the lesion and identify groups of affected oculomotor muscles, and the definition of thyroid function, is of great importance.

Treatment. Glucocorticoids (prednisolone, starting from 30-40 mg / day inwards, with contraindications from the gastrointestinal tract, corticosteroids are injected parenterally-metipred). Reducing swelling, exophthalmos, increasing the volume of eyeballs, reducing eye discomforts serve as indications for lowering the dose of corticosteroids, prescribing retrobulbar injections of dexazone or kenalog (under the control of intraocular pressure), dehydration therapy (triampur, furosemide), drugs that improve metabolic processes in Oculomotor muscles (riboksin, solkoseril), and neuronego-conduction stimulation-proserin. Magnetotherapy may be useful in the orbit region. In severe cases, with severe edema, no effect of corticosteroid therapy-X-ray therapy on the orbit region. Drying of the cornea is prevented by gluing the eyelids or using protective films. A diet with salt and liquid restriction. In case of thyroid dysfunction, correction is mandatory. In cases of severe disease, corrective operations on the muscles of the orbit and retrobulbar fiber.