Eye changes in endocrine disorders

The mirror of a person's soul is his eyes. Eyes can not only tell about inner experiences, emotions, character of a person, but also provide information about hormonal disorders. After all, it's no secret to anyone that all changes in the body sooner or later necessarily manifest themselves in appearance. The same goes for the eyes. Many diseases are determined by the eyes. According to the cornea - diseases of the internal organs, and in terms of the volume and size of the eyes - the presence of endocrine disorders. How do hormonal disorders affect the size of the eye sockets? What disorders of the eye structure can occur from endocrine pathologies? Read on estet-portal.com

Causes of endocrine ophthalmopathy

Endocrine ophthalmopathy, or Graves' ophthalmopathy, thyrotoxic exophthalmos - diseases of the muscles and tissues of the eyes of an autoimmune nature, which leads to a whole range of eye symptoms.

Among the causes are bacterial (Yersinia enterocolitica), viral (retroviruses), and it is also believed that smoking, alcohol and stress can also contribute to the development of ophthalmopathy. It is based on a pathological process in the soft tissues of the orbit, which is caused by a dysfunction of the thyroid gland. The nature and degree of damage in this case may be different.

Theories of the pathogenesis of ophthalmopathy in hormonal disorders

There are 2 theories of the mechanism of the pathological process in the tissues of the eye sockets during the development of ophthalmopathy.

First theory. The reaction of the response nature of antibodies to the thyroid gland in a cross way with the tissues of the orbit. Often occurs when patients have diffuse toxic goiter.

Second theory. An independent disease with autoimmune damage to the tissues of the eye.

Antibodies damage eye tissue, causing inflammation, swelling, and an increase in eye volume. With an increase in the volume of the muscles of the oculomotor apparatus, the retrobulbar pressure increases.

Exophthalmos is a clinical manifestation of endocrine ophthalmopathy

There are several types of exophthalmos in endocrine ophthalmopathy.

1. Thyrotoxic exophthalmos. It may not always be the cause of changes in retrobulbar tissues. This may be the cause of thyrotoxicosis. At the same time, the palpebral fissure is expanded due to retraction of the upper eyelid. Exophthalmos, if present, is no more than 2 mm. Patients with thyrotoxic exophthalmos have a fixed gaze, as they blink very rarely. Graefe's symptom is detected, in which a strip of sclera is visible when looking down over the upper limbus, when the eyes are closed, a tremor is observed, while they are completely closed. The volume of muscle movements around the eye is not changed, there are no pathologies in the fundus of the eye, the functioning of the eye is not impaired, reposition is not difficult. The described symptoms disappear after treatment of hyperthyroidism.
2. Edematous exophthalmos is always bilateral, and eye involvement occurs at different times, with an interval of several months. This exophthalmos has 3 stages:
   • Compensated stage. It begins with partial ptosis - the upper eyelid drops somewhat in the morning, by the evening the eyelid occupies a normal position. The tremor of the closed eyelids persists. At this stage of the process, the palpebral fissure closes completely. Later this ptosis develops into permanent retraction of the upper eyelid.
   • Subcompensation stage. White chemosis appears along the lower eyelid, as well as at the outer canthus of the eye. This is accompanied by non-inflammatory swelling of the tissues around the orbit and increased pressure in the eye. There is a sharp swelling of the cellular tissue of the eye, swelling and infiltration of cells of the external eye muscles. Symptom of the cross – this is a pathognomonic sign of edematous exophthalmos. The pressure inside the eye does not change only when it is in a straight position. And when you look up, due to squeezing the eye with enlarged rectus eyelid muscles, the pressure rises.
   • Stage of decompensation. An aggressive increase in symptoms is characteristic - a sharp exophthalmos, the palpebral fissure does not close, the eye is motionless. Optical neuropathy appears, which turns into atrophy. Without therapy, such exophthalmos provokes immobilization of the eyes and tissue fibrosis. Also, because of the corneal walleye, vision is sharply reduced. Sometimes the reason for this is atrophy of the optic nerve.
3. Endocrine myopathy. The process often occurs in males in the presence of a state of hypothyroidism and is bilateral. The disease begins with diplopia. Sharp edema is not observed. Fibrosis develops within a few months.

Methods for detecting ophthalmopathy in hormonal disorders

In most cases, ophthalmopathy develops simultaneously or after the detection of diffuse toxic goiter or precedes the development of thyrotoxicosis (euthyroid Graves' disease).

To determine the activity of the thyroid gland, the level of T3, T4 free and TSH is determined. In the active phase of the disease, the concentration of glycosaminoglycans in the urine increases. This allows diagnosing the activity of the process and the effectiveness of the treatment.

Of the instrumental studies, ultrasound and CT of the orbit are used. When making a diagnosis, differentiation with exophthalmos of tumor genesis, hemorrhage or tumor process in the orbit is necessary. An increase in the size of the eyeball itself occurs with glaucoma and a high degree of myopia, damage to the adjacent sinuses.

Treatment of exophthalmos in endocrine ophthalmopathy

Treatment of exophthalmos in endocrine ophthalmopathies should be comprehensive. Hospitalization and / or surgical treatment is indicated for severe process. Both endocrinologists and ophthalmologists take part in the therapy of exophthalmos. Treatment is with levothyroxine under the control of TSH levels. After treatment, it is recommended to check the function of the thyroid gland once every six months.

 When the structure and function of the eye are disturbed, the working capacity and quality of life of patients are significantly reduced. Therefore, it is very important to detect endocrine ophthalmopathies in time and take measures to avoid exophthalmos.