What is invasive endocrine exophthalmos?

summary

Endocrine invasive exophthalmos, also known as malignant exophthalmos Graves disease, is an autoimmune disease that endangers vision and damages appearance, and presents progressive development, with many causes. The main clinical manifestation is exophthalmos, which is unilateral or bilateral, accompanied by eyeball and surrounding soft tissue involvement. In severe cases, the visual acuity is affected or blindness is caused by optic nerve damage. The degree of exophthalmos is not parallel to the severity of hyperthyroidism, and the onset can be urgent or slow. Exophthalmos after effective treatment, the condition can be alleviated, but the eyes rarely return to normal. Now let's talk about what is invasive endocrine exophthalmos?

What is invasive endocrine exophthalmos?

1. The occurrence of endocrine exophthalmos is mainly related to autoimmunity. At the same time of thyroid autoimmune damage, the body also produces autoantibodies against eye tissue. Antibodies against eye tissue can cause eye tissue damage. The main pathological changes of ocular tissues are as follows: (1) edema and infiltration of inflammatory cells such as lymphocytes, plasma cells, macrophages and mast cells appear in the fat and connective tissue in the retrobulbar space, which is characterized by the increase of the volume of these soft tissues. The occurrence of endocrine exophthalmos is mainly related to autoimmunity. At the same time of thyroid autoimmune damage, the body also produces autoantibodies against eye tissue.

2. For local treatment, pay attention to eye rest, wear black or tan glasses to avoid strong light and various external stimuli, and use antibacterial eye ointment and eye mask during sleep to avoid inflammation of the exposed part of the cornea. One side eye mask was used to reduce diplopia, high pillow position, salt intake was controlled, and antibacterial eye drops (ointment) and cortisone eye drops were used alternately. 0.5% ～ 1% methylcellulose or 0.5% hydrocortisone solution had better effect on relieving eye irritation. Retrobulbar injection of hyaluronidase has poor curative effect. Methylprednisolone may be effective by intramuscular conus injection. If there is serious exophthalmos or even conjunctival blister like bulging, such as goldfish eye, it is better to quickly perform eyelid lateral suture, which is a more effective method to protect the cornea. After the exophthalmos is improved, the suture can be removed, but the eyelid suture can be secondary infection, leaving scars to form serrated eyelid margin. If the exophthalmos is serious and the vision is threatened, all kinds of intraorbital decompression can be used when the local and systemic treatment is ineffective, but it is rarely used in China.

3. Retrobulbar or pituitary irradiation should be considered when high-dose corticosteroids are ineffective or corticosteroids cannot be used due to contraindications. Radiation can inhibit the sensitive lymphocytes. When the above-mentioned therapy fails to work well, retrobulbar radiotherapy can get better effect on ocular infiltration and hyperemia, but has little effect on exophthalmos. The curative effect of pituitary irradiation is uncertain, and there is still the risk of pituitary dysfunction, so it is rarely used.

matters needing attention

Diet nursing: reasonable diet, high calorie, high protein, high vitamin, digestible low salt and low iodine diet; Avoid eating irritating food or drink (such as strong tea, coffee, etc.) and limit drinking water appropriately. Recent studies have found that smoking is closely related to invasive exophthalmos, and the presence and severity of eye symptoms are related to the amount of smoking, so patients with smoking habits should quit smoking.