Phenotypes of endocrine ophthalmopathy: clinical manifestation and tomographic characteristics
Irina M. Belovalova,
Natalya Yu. Sviridenko,
Elena G. Bessmertnaya,
Anna A. Chepurina,
Marina S. Sheremeta,
Alexander A. Mikheenkov https://doi.org/10.14341/probl9618
Abstract
The clinical manifetstations of endocrine orbitopathy (EOP) significantly because autoimmune process may involve various anatomical structures of the eye. Choosing an effective method for EOP treatment requires to determine the selectivity of orbital tissue damage, which is difficult when only clinical criteria are applied. 102 patients with EOP and Graves’ disease were examined. All patients underwent the standard ophthalmological examination and multispiral computed tomography of orbits. The analysis of clinical and tomographic parameters allowed us to distinguish 3 variants of EOP flow: classical, lipogenic, and myogenic. The prevailing symptoms of patients with the lipogenic variant were distinct exophthalmos without a disturbance of the function of extraocular muscles (EOM) and visual disturbances. Oculomotor disorders, diplopia, strabismus, and decreased vision were prevalent in patients with the myogenic variant. Patients with the classical variant suffered from exophthalmos, periorbital edema, and oculomotor disorders. The identification of independent clinical variants of EOP with specific clinical symptoms and different tomographic characteristics testifies different pathogenetic mechanisms of EOP development is to determine personalized approaches to treatment.
Supporting agencies: The study was performed with financial support of Russian scientific Foundation (grant number 17-75-30035)
About the Authors
Irina M. BelovalovaEndocrinology Research Centre
Russian Federation
MD, PhD
Natalya Yu. Sviridenko
Endocrinology Research Centre
Russian Federation
MD, PhD, Professor
Elena G. Bessmertnaya
Endocrinology Research Centre
Russian Federation
MD, PhD
Anna A. Chepurina
Endocrinology Research Centre
Russian Federation
MD, PhD
Marina S. Sheremeta
Endocrinology Research Centre
Russian Federation
MD, PhD
Alexander A. Mikheenkov
Endocrinology Research Centre
Russian Federation
endocrinologist
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Supplementary files
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1. Fig. 1. Chronological relationship between the manifestation of thyrotoxicosis in Graves' disease and the appearance of symptoms of endocrine ophthalmopathy. | |
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2. Рисунки к статье | |
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3. Fig. 2. Eye symptoms associated with thyrotoxicosis: retraction of the upper eyelids (a, b). | |
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4. Fig. 3. The frequency of detection of 11 eye symptoms in patients with Graves' disease after surgical treatment. | |
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5. Fig. 4. Lipogenic variant of endocrine ophthalmopathy. a - a photograph of a patient with severe exophthalmos | |
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6. Fig. 4. Lipogenic variant of endocrine ophthalmopathy. b - MSCT of the orbits, axial projection (the eyeballs are located above the interscale line - the white line). | |
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7. Fig. 5. Clinical manifestations of EOP with selective involvement of EOM. Pronounced asymmetry of the position of the eyeballs in orbits. and - paralytic squint, mainly vertical type | |
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8. Fig. 5. Clinical manifestations of EOP with selective involvement of EOM. Pronounced asymmetry of the position of the eyeballs in orbits. b - MSCT, coronal projection OS - an increase in the lower straight and outer rectus muscles. | |
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9. Fig. 6. Clinical manifestations of EOP with involvement of EOM and RBC. a - photo | |
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10. Fig. 6. Clinical manifestations of EOP with involvement of EOM and RBC. b - MSCT, axial projection: compression of the optic nerve (white arrows) in a patient with a severe form of image intensifier, complicated by optical neuropathy. | |
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11. Рис. 7. МСКТ, корональная проекция: визуализируются увеличенные слезные железы (белые стрелки) | |
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12. Fig. 8. Clinical manifestations of endocrine ophthalmopathy with optic neuropathy. a - photo of a patient with EOP and optic neuropathy | |
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13. Fig. 8. Clinical manifestations of endocrine ophthalmopathy with optic neuropathy. b - MSCT of the orbits, coronal projection - compression of the optic nerve (white arrows) at the apex of the orbit increased in volume of the EOM. | |
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14. Fig. 9. Pronounced bilateral lagophthalmos. a - non-closure of the eyelids during sleep | |
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15. Fig. 9. Pronounced bilateral lagophthalmos. b - compression of the optic nerve (white arrows) in a patient with a severe form of image intensifier, complicated by optic neuropathy and severe exophthalmos. | |
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Review
For citations:
Belovalova I.M., Sviridenko N.Yu., Bessmertnaya E.G., Chepurina A.A., Sheremeta M.S., Mikheenkov A.A. Phenotypes of endocrine ophthalmopathy: clinical manifestation and tomographic characteristics. Problems of Endocrinology. 2018;64(6):383-389. https://doi.org/10.14341/probl9618
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