The symptom of Shtelvag is one of the manifestations of hyperthyroidism. The disease is associated with an increase in the hormonal activity of the gland. With thyroid or endocrine ophthalmopathy (EOP), that is, "eye" symptoms of diffuse toxic goiter (DTZ), the clinical picture has eye symptoms: Gref, Moebius, Stelvag, Krauss, Kocher, Delrimple, Jellinek, less often Rosenbach, Botkin. Ophthalmic disorders occur in 20-91.4% of cases. The image intensifier is mild, moderate and severe.
Symptom Gref
It is expressed in that when looking down the upper eyelid lags behind, and a strip of sclera becomes visible. This phenomenon occurs because the tone of the muscles that control the eyelid is increased under the influence of an excess of T3 and T4 in the blood.
By the way, this symptom does not differ in constancy. It can also occur in healthy people with myopia (myopia).
Symptom of Moebius
Appears in connection with the weakness of the adducting eye muscles. At the same time, convergence weakens, and a person loses the ability to fix his gaze on nearby objects. It happens in healthy people.
Shtelvag's syndrome
Pusher symptom is a rare blink. Due to wrinkling (retraction) of the upper eyelid and protrusion of the eyeball, the impression of an increase in the palpebral fissure is created. This symptom of Shtelvag, which often occurs with hyperthyroidism and is considered one of its manifestations, does not occur in all patients. In addition, a symptom can also occur with some diseases of the brain - Parkinson's disease, postencephalitic parkinsonism, akinetic-rigid syndrome (extrapyramidal parkinsonism phenomenon), Bell's paralysis. A description of this symptom was made by an ophthalmologist from Austria Karl Stälvag.
What is a symptom of Stelvag? This is a rare blink (less than 3 times per minute), which is regarded as a sign of decreased sensitivity of the cornea. The patient's gaze looks motionless, frozen.
Why do these symptoms occur?
Interpretation of symptoms on the part of the eyes is difficult, since the mechanism is not fully understood. It was said that with thyroid pathologies inside the eye socket, swelling of muscles and soft tissues occurs. They push the eyeball forward and cause various eye symptoms - an additional reason.
Currently, it has been proven that exophthalmos is due to the pathological tone of m. orbitalis (muller muscle). Therefore, the growth of retrobulbar fatty tissue, the expansion of orbital veins and arteries does not play a role. This is evidenced by the absence of changes in the fundus.
Secondly, the main confirmation of this point of view is that exophthalmos can occur in a few hours. This is due to irritation of the cervical sympathetic nerve. It causes a sharp reduction in m.orbitalis. There is an embracing behind the eyeball and, as it were, pushing it forward.
In addition, veins and lymphatic vessels pass through the indicated muscle, and when the muscle suddenly contracted, they are compressed, and the edema of the eyelids and retrobulbar space becomes the answer. This is a more correct explanation of pathogenesis. Glaucoma with thyrotoxicosis may not appear, this also takes place.
Rare blinking (Shtelvag symptom), wide opening of the palpebral fissures (Delrimply symptom), and a special shine of the eyes due to increased muscle tone of the cartilage of the eyelids. And finally, with hyperthyroidism, in addition to autoimmune inflammation of the eye, the activity of the sympathetic-adrenal system is increased. She, in turn, enhances the tone of the muscles that raise the upper eyelid. But the mechanism of neurohormonal disorders with which eye symptoms are associated is not fully understood today.
Is their appearance mandatory?
Not all ocular symptoms of DTZ may appear in one patient. More common than others:
- Gref, Ekrota, Kocher, Dalrympl - with them the function of the upper eyelid is impaired.
- Symptoms of Jaffe and Geoffrey, Rosenbach symptoms, Shtelvag symptom associated with neurogenic factors.
- Symptoms of Moebius, Wilder, due to impaired convergence of the eyes.
But this does not mean that eye symptoms are mandatory for goiter. They may be absent altogether. Therefore, to consider them a manifestation of the severity of DTZ is wrong. In severe thyrotoxicosis, they may not occur.
Treatment
Why should eye symptoms be treated? The fact is that they not only change the appearance of the patient (worsen him), but also disrupt vision, causing him to decrease, conjunctivitis, subluxation of the eyeball, eye pain and discomfort. Effective therapy of precisely these symptoms has not been developed today.
Treatment of the symptom of Stelvag and other eye manifestations gives the result only in the active phase of the goiter. When the inflammatory process subsides, sometimes you have to resort to surgical intervention.
The treatment of ocular symptoms is mainly pathogenetic during remissions. In other words, this is any eye protection. It can be medical, supporting physiology and surgical, even in the form of radiation. Artificial tear preparations are indicated for all patients (“Hilo-chest of drawers”, “Visomitin”) or moisturizing gels (“Oftagel”, “Korneregel”).
But the main thing is the treatment of the goiter itself. With a mild degree of EOP, therapy is usually not required. In moderate and severe forms, glucocorticoidosteroids (Prednisolone, Metipred) and radiation therapy are used.
"Prednisone" is prescribed for a long time and in high doses. As the condition improves, the doses are gradually reduced. More effective is the use of drugs parenterally in a vein. It is carried out only stationary. Irradiation of the orbits is used only as an addition to medications. Prevention of exophthalmos also consists in the timely treatment of thyrotoxicosis.