Endocrine orbitopathy is a common symptom of Graves' disease. In Graves' disease, autoantibodies develop that bind certain receptor molecules for thyroid hormones.
This mainly occurs in the area of the thyroid gland, on connective tissue cells or in the area behind the eyes. If these autoimmune antibodies bind to these cells and to the tissue, this leads to inflammatory reactions. The result is connective tissue remodeling.
At the same time, the inflammation causes immune cells to migrate. Fluid transfer into the tissue leads to edema formation. Increased connective tissue fibers are also formed. If these processes take place behind the eye, the volume increases. The eye bulges forward, resulting in the characteristic exophthalmos or endocrine orbitopathy.
It is interesting to note that women are three times more likely to suffer from endocrine orbitopathy than men.
As the disease progresses, the tissue around the eyeball continues to increase in mass. It usually presses on both sides of the eyeballs. Every second patient with Graves' disease develops endocrine orbitopathy.
The eyeballs can protrude significantly beyond the eye socket and therefore appear very large. Eyelid closure is also restricted with increasing exophthalmos .
A number of other symptoms can occur in connection with the protruding eyes, such as
- dry eyes
- increased lacrimation
- Pressure or pain in the eye
- swelling of the eyelids
- reduced vision,
- sensitivity to light, etc.
Protruding eyeballs, swelling and redness in the eyelids and conjunctiva are characteristic @ Andriy Blokhin /AdobeStock
If Graves' disease or hyperthyroidism is known, an expert eye examination by an ophthalmologist is sufficient. They can diagnose endocrine orbitopathy.
If there is no pre-existing condition, doctors also examine the thyroid gland. The front of the neck can be used to feel the thyroid gland. In case of doubt, doctors use an ultrasound device to confirm the findings .
To clarify an endocrine disorder such as Graves' disease, the endocrine orbitopathy specialist will arrange for a blood test. This allows them to check the thyroid values.
The most important values include TSH, the thyroid-stimulating hormone. There are also thyroid antibodies such as TRAK or TPO-AK, which circulate in the blood in the case of Graves' disease.
The doctor performs a thyroid examination if endocrine orbitopathy is suspected @ Andriy Blokhin /AdobeStock
The most important thing is for patients to achieve a balanced metabolic state. This is achieved through drug regulation.
If the eye disease progresses despite a normal metabolic state, glucocorticoids or X-ray irradiation behind the eyeball can help.
The IGF receptor inhibitor teprotumumab is another medical treatment option.
If vision is acutely threatened, surgery is necessary to relieve the condition if glucocorticoid therapy is unsuccessful.
The surgical procedures include
- Lateral orbital decompression or
- Endonasal orbital decompression
Early treatment further improves the good prospects of recovery, even if the exophthalmos cannot be cured.
Smoking, on the other hand, significantlyworsens the course and prognosis. Patients should therefore refrain from smoking completely.
Exophthalmos affects various medical disciplines:
Specialist knowledge in the field of eye surgery is required for the surgical treatment of endocrine orbitopathy.
Endocrine orbitopathy specialists and medical centers with extensive experience in this field can be found above.
