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.
The disease is based on autoimmune disorders leading to changes in the extraocular muscles and retrobulbar tissue: a violation of the structure of muscle fibers, diffuse cellular infiltration by lymphocytes and plasma cells, accumulation of mucopolysaccharides, swelling of muscles and fiber, causing an increase in the volume of retrobulbar tissues, impaired microcirculation with subsequent proliferation of connective tissue and the development of fibrosis. Often associated with autoimmune thyroid disease.
Symptoms of endocrine ophthalmopathy. Patients complain of lacrimation, especially in the wind, photophobia, a feeling of pressure in the eyes, double vision (especially when looking up and sideways), protrusion of the eyeballs. On examination, pronounced exophthalmos is noted, more often bilateral. Normally, with exophthalmometry, the protrusion of the eyeballs corresponds to 15-18 mm. In sick patients, the protrusion of the eyeballs can exceed these figures by 2-8 mm. With the edematous form of the disease, pronounced edema of the eyelids, conjunctiva, and injection of scleral vessels are noted. With the predominant involvement of the extraocular muscles in the pathological process, the symptoms caused by their defeat come to the fore: the symptoms of Mobius, Graefe, Dalrymple, Shtelvag, etc .; limitation of the mobility of the eyeballs up to their complete immobility.
The fundus of the eye: swelling of the retina, optic discs, atrophy of the optic nerves. Concentric narrowing of visual fields, central scotomas are noted. There may be ulceration of the cornea, its perforation, infection. For the diagnosis, ultrasound examination of the retrobulbar space is of great importance, which makes it possible to determine the severity of damage and to identify groups of affected oculomotor muscles, and to determine the function of the thyroid gland.