Endocrine ophthalmopathy (EO) in 40-60% of casesis combined with Based's disease (less often with Hashimoto's thyroiditis, sometimes with congenital hypothyroidism and multiple endocrine neoplasia or adenomatosis). However, it is considered an independent disease - endocrine-mediated changes on the part of the eyes can be observed without a hyperthyroid condition.
Euthyroid form of endocrine ophthalmopathycan go over to hyperthyroid and, on the contrary, eye symptoms under certain circumstances develop after medical or surgical treatment of hyperthyroidism.
A quarter of patients with endocrine ophthalmopathy simultaneously have hyperthyroidism. In a quarter of patients with severe EA, it develops within a year before the onset of hyperthyroidism.
The pathogenesis of endocrine ophthalmopathy is unknown. Perhaps, a certain role is played by autoimmune processes.
Clinical evaluation and diagnosis of endocrineOphthalmopathy is often difficult, especially since protrusion of the eyeball in 15% of cases develops first on one side, and there is no direct connection between the severity of EO and hyperthyroidism.
Of great importance is the examination of the ophthalmologist, withnecessity - computed tomography of the orbit. The cause of endocrine ophthalmopathy is the retrobulbar deposition of mucopolysaccharides, cellular infiltration of the retrobulbar space and sometimes extraocular eye muscles, as well as mucinous edema. With unilateral exophthalmos, nonendocrine processes, such as orbital, periorbital and intracranial tumors and metastases (the meningeum of the Turkish saddle), then hemoblastoses, phakomatoses, bone diseases and inflammatory diseases (phlegmon of the orbit) should be assumed first.
Endocrine ophthalmopathy is divided into 6degrees of gravity according to Werner. At the initial stages of endocrine ophthalmopathy patients complain about eyelid edema, pressure and sensation of foreign body in the eye area, photophobia, lacrimation and blurred vision. Then the retraction of the upper eyelids develops (Dalrymple's sign) and finally the protrusion of the eyeballs ("poplar eyes"), which can take extreme dimensions already at III-IV severity (bilateral EE III degree with congestive blood filling, chemosis and eye shine due to increased protrusion of the eyeball and the widening of the eye slit on the right are more pronounced).
Parezy of the eye muscles within the endocrineophthalmopathy of the IV-VI degree leads in the end to double vision. With left-sided EE IV degree, there is a significant limitation of lifting of the left eyeball when looking upwards (Dalrymple's pseudo-symptom).
"Edema of the eyelids, photophobia, lacrimation and other signs of endocrine ophthalmopathy" and other articles from the section Differential diagnosis by external signs