Endocrine orbitopathy

Endocrine orbitopathy is a disease associated with autoimmune thyroid disease (most commonly Graves-Basedow thyroiditis ). It is also known as endocrine ophthalmopathy, but it is recommended to use the name orbitopathy, as it does not affect the eyeball but the tissues of the orbit.

Pathophysiology
Autoantibodies react with the tissues (mainly adipose and connective tissue) of the orbit. They infiltrate the posterior part of the orbit and cause inflammation with tissue leakage, increasing its volume.

Diagnosis
Exophthalmos is a noticeable symptom. In the orbit, there is a small space bounded by the bone, and as the pressure increases, the eyeball is pushed forward, out of the orbit. The primary symptom is upper eyelid retraction and limited mobility when looking down ( Graefe's flag ). With a large protrusion of the bulbs, the patient cannot close the eyelids ( lagophthalmus ) and there is a risk of drying out and ulceration of the cornea. The ligament of the oculomotor muscles is also affected, this symptom remains latent for a long time. Muscles fibroticize and retract. Initially, their movement is limited only in the extreme positions, with a long duration of untreated thyroiditis, the involvement of the oculomotor muscles is manifested by diplopia. Even in direct view due to muscle paralysis. An experienced doctor can detect the involvement of the oculomotor muscles during an ultrasound examination.

Treatment

 * Glucocorticoids
 * Immunosuppressants
 * Thyrostatics (thiamazole, propylthiouracil),
 * TTE (total thyroidectomy),
 * Radioiodine treatment,
 * Symptomatic treatment of lagophthalmos: moistening of the cornea (artificial tears, eye ointments).

Related

 * Graves' disease
 * Hyperthyroidism