Endocrine ophthalmopathy is a lesion of the muscles and retrobulbar tissue of the eyeball that occurs with an autoimmune thyroid disease. In most patients, this disease develops in the presence of diffuse toxic goiter or thyrotoxicosis. Thyroiditis is much less common, or an isolated lesion of the eye orbits may be observed. This ailment very often leads to the development of buccalis, and in addition, to an increase in pressure inside the eyes and a split image. Next, we find out what symptoms are observed in people with this disease, and also find out how its treatment is currently being carried out.
Symptoms of pathology
With endocrine ophthalmopathy, people develop exophthalmos, which is characterized by a protrusion of the eyes. In this case, the volume of the upper eyelid decreases, because of this, the incision of the palpebral fissures increases, and a sick person cannot completely close his eyes. Symptoms of the disease usually increase over eighteen months. The following symptoms are the main symptoms of endocrine ophthalmopathy:
- The presence of a sensation of sand in the eyes.
- The appearance of photophobia and lacrimation.
- In the presence of ophthalmopathy, people experience dry eyes.
- The development of diplopia, against the background of such a state, the image doubles while looking away in the other direction.
- The appearance of headaches.
- The development of exophthalmos, that is, eye-glaze.
- The occurrence of a symptom of Kocher.
- Strabismus development.
- The appearance of pigmentation on the skin of the eyelids.
- A rare blink along with the inability to avert the eyes in different directions.
- Trembling and bending of the eyelids.
Exophthalmos against the background of this disease can be one-sided or affects both eyes at once. Due to incomplete closure of the eyelids, ulceration of the cornea is carried out, and in addition, chronic conjunctivitis develops along with iridocyclitis and dry eye syndrome. In the presence of severe edema, compression of the optic nerve is observed, which leads to visual impairment, and at the same time to atrophy of the nerve fiber. Damage to the fundus leads to an increase in intraocular pressure, at the same time, a person develops squint with retinal vein thrombosis.
In the event that in the presence of endocrine ophthalmopathy, myopathy of the oculomotor muscles is still developing at the same time, then image ghosting is formed, and the disease is characterized by a progressive course. This combination of diagnoses is found mainly in men with the development of thyroid hypothyroidism or against the background of an euthyroid state. Exophthalmos can later join. As a rule, fiber swelling is absent, but muscle volume increases, and the patient is not able to move his eyes up or down. Infiltration areas are quickly replaced by fibrous tissue.
Symptoms of edematous exophthalmos
Edematous endocrine ophthalmopathy is characterized by bilateral eye damage. This form of the disease has the following three stages of the course:
- The stage of ophthalmopathy compensation usually develops gradually. Patients can note the omission of the upper eyelids in the morning, and by the evening the pathological condition is normal. During the progression of the disease, retraction of the eyelids occurs and the palpebral fissure increases. In addition, muscle tone increases and contracture occurs.
- Subcompensation of endocrine ophthalmopathy is accompanied by an increase in intraocular pressure along with edema of retrobulbar tissue, which is non-inflammatory in nature. In addition, the lower eyelid may be affected by chemosis. Symptoms of effervescence can be quite clearly manifested, and the eyelids can not completely close. In addition, the small vessels of the sclera turn out to be sinuous and form a cross-shaped pattern.
- As for the decompensation stage, it is characterized by an increase in clinical symptoms. Due to the presence of edema, the optic nerve is damaged. The cornea, in turn, ulcerates and keratopathy forms. Without treatment, nerve fibers can atrophy, and vision due to the formation of the eyesore worsens.
Endocrine ophthalmopathy most often does not lead to vision loss, but can significantly worsen it due to complications of compression neuropathy or keratitis.
What is the diagnosis of endocrine ophthalmopathy?
Differential diagnosis
To assess the state of the thyroid gland, patients, as a rule, pass a blood test to determine the level of thyroid hormones and antibodies to specific receptors. If a person has endocrine ophthalmopathy, the concentration of antibodies T3 and T4 exceeds the norm.
Ultrasound examination along with thyroid scintigraphy makes it possible to determine the size with the degree of enlargement of the organ, also thanks to these research methods it is possible to identify nodular formations. In the event that large nodes are found that exceed one centimeter in diameter, a fine-needle aspiration biopsy is performed .
Ophthalmic examination of the patient includes an ultrasound examination of the orbit of the fundus along with measuring intraocular pressure, perimetry and checking the visual field. In addition, doctors evaluate the condition of the cornea with the degree of mobility of the eyeballs. Additionally, it is possible to assign a computer or magnetic resonance imaging of the orbit. A muscle biopsy is often taken.
Pathology is differentiated with myasthenia, as well as with ailments such as pseudoexophthalmus with myopia, eye phlegmon, malignant tumors of the orbit, neuropathy, and the like.
Treatment methods
Treatment of endocrine ophthalmopathy is prescribed taking into account the severity, as well as the causes of the development of pathology. Conservative and surgical methods of therapy are used. Violation of the thyroid gland is eliminated under the supervision of an endocrinologist. Patients are prescribed hormone replacement therapy or treatment with thyreostatics that suppress the hypersecretion of antibodies T3 and T4. With the ineffectiveness of drugs, a complete or partial removal of the thyroid gland is performed.
To relieve the symptoms of acute inflammation in endocrine ophthalmopathy, glucocorticoids, for example, Prednisolone, are prescribed. Steroids may also be prescribed. "Cyclosporin" is prescribed to patients to suppress the immune process, this drug is able to change the function of t-lymphocytes. It is often prescribed as part of the complex therapy of endocrine ophthalmopathy (in the photo below you can see signs of the disease).
Hormone therapy is carried out with neuropathies, and in addition, in the presence of a severe degree of inflammation. Hormones are administered intravenously in a short time in large doses. In the event that after two days the desired result is not achieved, surgery is performed.
As part of the treatment of pathology, the technique of retrobulbar glucocorticoid administration is also used. Drugs are introduced into orbits to a depth of one centimeter. This method makes it possible to increase the concentration of drugs directly in the affected tissue.
Endocrine ophthalmopathy (before and after photos are presented in the article), which is accompanied by persistent diplopia, visual impairment and inflammatory processes, is treated with radiation therapy. X-rays contribute to the destruction of fibroblasts and pathological t-lymphocytes. A good result can be achieved with early treatment as part of the integrated use of glucocorticosteroids.
As part of the symptomatic treatment, drugs are prescribed that normalize metabolism, and eye antibacterial drops are also used for endocrine ophthalmopathy along with gels and vitamins A and E. Physiotherapeutic procedures are often carried out in the form of magnetotherapy, electrophoresis with aloe, and so on.
Radioiodine therapy as a treatment
Radioiodine therapy in this disease is carried out by taking active iodine molecules, which are able to accumulate in the thyroid tissue, causing the destruction of its cells. As a result of this, the secretion of thyroid hormones may decrease with the further development of hypothyroidism. As a rule, in addition to patients, thyroxine replacement therapy is prescribed.
Surgical intervention is prescribed only with a large thyroid gland, and also factors such as compression of the esophagus, abnormal location of the goiter and the ineffectiveness of conservative treatment can affect this. As part of the operation, either a partial excision of the organ is performed, or the thyroid gland is completely removed. What other treatment for endocrine ophthalmopathy is performed?
Surgical treatment
Indications for surgical intervention are:
- Lack of effectiveness of conservative therapy.
- The development of compression optic neuropathy.
- The appearance of subluxation of the eyeball.
- The development of severe exophthalmos.
- Symptoms of severe corneal damage.
Decompression of the orbits on the background of endocrine ophthalmopathy can prevent eye death, increasing the volume of the orbits. During the operation, a partial removal of the orbit wall and the affected fiber is performed, this makes it possible to slow down the progression of the disease, reducing intraocular pressure and reducing exophthalmos.
How to treat endocrine ophthalmopathy is interesting to many patients.
Decompression of the orbits is carried out in several of the following ways:
- The use of the transantral method is to remove the lower or outer wall of the orbit. A complication after surgery may be a violation of sensitivity in the periorbital region.
- Transfrontal decompression is performed by excision of the front walls of the orbit with access through the frontal bone. As a result, the symptoms of exophthalmos decrease and the pressure decreases. But with this technique, there are risks of bleeding, damage to brain structures and meningitis.
- One of the methods also is the removal of retrobulbar cellulose up to six cubic millimeters. This method is used in the normal state of soft tissue, which is determined according to the results of computed tomography or magnetic resonance imaging.
- Transendmoidal endoscopic decompression involves the removal of the medial walls of the orbit to the sphenoid sinuses. As a result of such an operation, retrobulbar tissue shifts to the area of the ethmoid labyrinth. As a result, the position of the eyeballs is normalized and, as a result, regression of exophthalmos is achieved.
Surgical correction of the oculomotor muscles in the presence of strabismus or diplopia is carried out during the period of stabilization of the patient's condition. In order to achieve the desired results and improve binocular vision in a patient, several operations may be required at once. In order to eliminate a cosmetic defect, a surgical lengthening of the eyelids is performed. Moreover, in order to reduce retraction and completely close the eyes, botulinum toxin is injected or the subconjunctival Triamcinolone is used.
Conducting lateral tarsraphia, involving the closure of the edges of the eyelids, makes it possible to achieve their correction, but the effectiveness of such a procedure is negligible. Performing a tenotomy of the Mueller muscles makes it possible to achieve the omission of the eyelids. The final stage in surgical treatment is blepharoplasty along with dacryopexy of the lacrimal openings.
Prognosis for patients
If all clinical recommendations for endocrine ophthalmopathy are followed, the prognosis is favorable.
The effectiveness of therapy directly depends on how timely medications were prescribed to the person. Proper treatment of this disease at an early stage helps to prevent the progression of the disease and the development of various complications. Thanks to proper treatment, prolonged remission can be achieved. Deterioration is noted, as a rule, only in five percent of patients.
People who suffer from symptoms of endocrine ophthalmopathy are advised to completely abandon bad habits, and in addition, use dark glasses and apply eye drops to protect the cornea from drying out. Among other things, such patients must necessarily be registered in the dispensary. They need to undergo regular examinations by an ophthalmologist and endocrinologist. Patients should take thyreostatics along with drugs for replacement therapy, which are prescribed by a doctor. Once every three months, it is necessary to donate blood to thyroid hormones.
Endocrine ophthalmopathy is characterized by damage to the retrobulbar tissue of the eye orbits with varying degrees of intensity. Symptoms of pathology most often develop with thyrotoxicosis of the thyroid gland, which is caused by hypersecretion of thyroid hormones due to certain autoimmune processes. In this case, treatment must be carried out comprehensively, including the administration of thyreostatics along with glucocorticoids, steroids and immunosuppressants. In the presence of severe neuropathy, surgical decompression of the eye orbits is performed.
Endocrine Ophthalmopathy Reviews
In their reviews of a surgical operation against a background of pathology, people write that their general condition has improved and unpleasant symptoms have disappeared. The disadvantages of treatment include the need for hormonal drugs.
The treatment of endocrine ophthalmopathy according to reviews is most often successful.
It is also noted that after surgery, patients notice a minimum of complications. A positive point is a short rehabilitation period.
Reviews of endocrine ophthalmopathy are abundant.
Pregnancy
This disease is not dangerous for the expectant mother. The only thing that pregnant women should consider in case of diagnosing this disease is the possible consequences. Mostly we are talking about thyrotoxicosis and toxic goiter. These diseases can occur as a result of endocrine ophthalmopathy and require compulsory treatment under the supervision of appropriate specialists.
Preventive measures
The main goal of prevention is to eliminate the dysfunction of the glands that are responsible for the corresponding processes in the body. First of all, we are talking about hormones, but to prevent a malfunction in their work, a person needs to take the necessary tests every year. In addition, you need to go to the endocrinologist at least once a year, who will be able to detect a similar problem in time.
We examined such pathology as endocrine ophthalmopathy, and reviews of the cured.