2nd order Orbital decompression – surgical intervention aimed at relieving intraorbital pressure and/or reducing proptosis because of endocrine orbitopathy (EO, disease in which exophthalmos (protrusion of the eyeballs) occurs). Indications: primarily functional in cases of manifest or threatened visual deterioration (worsening of vision) and retrobulbar pressure sensation or for aesthetic reasons in cases of disfiguring … Exophthalmos: Surgical Therapy
To prevent exophthalmos because of Graves’ disease, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet High iodine intake Consumption of stimulants Tobacco (smoking) (considered a major factor aggravating the immune process). Psycho-social situation Stress
The following symptoms and complaints may indicate exophthalmos (protrusion of the eyes; googly eyes): Leading symptom Protrusion of the bulb of the eye from the eye socket (orbit) with simultaneous widening of the palpebral fissure. The following are symptoms and complaints of endocrine orbitopathy (EO) as the most common cause of exophthalmos: Exophthalmos (synonyms: endocrine … Exophthalmos: Symptoms, Complaints, Signs
Pathogenesis (development of disease) For the pathogenesis of exophthalmos, see under the particular disease that is the cause of exophthalmos. The most common cause of exophthalmos is endocrine orbitopathy (EO; hormonally induced disease of the agenic cavity(s) tissue), which occurs only in the setting of immunothyreopathies. In this case, exophthalmos is an extrathyroidal manifestation of … Exophthalmos: Causes
General measures In case of orbitopathy (protrusion of the eyeballs) – use artificial tears and tinted glasses with side shields if necessary and adopt a relatively upright sleeping position if possible; furthermore, the eyelids can be taped shut during sleep (watch glass bandage) Nicotine restriction (refrain from tobacco use) – smoking cessation is to be … Exophthalmos: Therapy
Therapeutic Objective In the presence of Graves’ disease: achievement of a euthyroid metabolic state (= thyroid values in the normal range). Therapy recommendations In the presence of Graves’ disease: see below Graves’ disease/drug therapy. In case of progression of orbitopathy (immunologically caused inflammation of the orbital contents/protruding eyes) despite euthyroid metabolic state → high-dose therapy … Exophthalmos: Drug Therapy
Obligatory medical device diagnostics Thyroid sonography (ultrasound examination of the thyroid gland) – as a basic examination to determine thyroid size and volume and any structural changes such as nodules[M. Graves’ disease: goiter with diffuse echo-poor, signs of infiltration are seen as homogeneous internal structures; in the Duplexsonographe shows increased vascularization / vascular proliferation or … Exophthalmos: Diagnostic Tests
Eyes and Ocular Appendages (H00-H59). Orbital hematoma (blue eye) – contusion with blood pooling in the orbit and surrounding skin area. Orbitaphlegmon – rare, dangerous disease of the eye socket (orbit) associated with infection of the eyelids and surrounding skin in front of the septum orbitale Endocrine, nutritional and metabolic diseases (E00-E90). Endocrine orbitopathy (hormonally … Exophthalmos: Or something else? Differential Diagnosis
The following are the most important diseases or complications that can be caused by exophthalmos (protruding eyes): Eyes and eye appendages (H00-H59). Desiccation keratitis (corneal damage due to desiccation)/exposure keratitis in the absence of/incomplete eyelid closure (lagophthalmos). Protrusio bulbi – protrusion of the eyeball from the orbit. Optic nerve compression in Graves’ disease with exophthalmos … Exophthalmos: Complications
Staging of endocrine orbitopathy (EO). Stage Description I Foreign body sensation Photophobia (light shyness) Retrobulbar pressure sensation (retrobulbar, i.e., behind the eyeball). II Eyelid retractions (retraction: shrinkage, shortening) and connective tissue involvement with: Chemosis (= edema of the conjunctiva): In the case of more severe conjunctivitis (inflammation of the conjunctiva) or In inflammatory processes of … Exophthalmos: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing) of skin, eyes, and entire body [wg: Alopecia* ? (hair loss, diffuse) Sweating, warm and humid skin* ? Eyes: exophthalmos (synonyms* : Ophthalmoptosis; ophthalmopathy; protrusio bulbi; popularly known as … Exophthalmos: Examination
Laboratory diagnostics in suspected diagnosis of Graves’ disease or autoimmune thyreopathy (chronic inflammatory thyroid disease caused by autoimmune processes). 1st-order laboratory parameters-obligatory laboratory tests. TSH ↓ (thyroid-stimulating hormone). T3 ↑ (triiodothyronine) and T4 ↑ (thyroxine) (in manifest hyperthyroidism). Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for … Exophthalmos: Test and Diagnosis
