Endocrine ophthalmopathy - symptoms and form of an illness. Endocrine ophthalmopathy - why? Causes, symptoms, diagnosis and treatment Endocrine ophthalmopathy treatment

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vitreousness - head symptom endocrine ophthalmopathy. Tse zhvoryuvannya vіdoma also like ophthalmopathy Graves, I will name it in honor of the doctor, which described the signs of pathology for the first time. At the same time, the back (retrobulbar) tissue is reflected in the organ of the zoru and the mouth of the full-time apple, which can be produced to the point of yo-handedness. Pathology appears with bulging eyes, lacrimation, swelling, conjunctiva. At the start of the stage, the healthy nerve atrophies and the zir is signi fi cantly lost.

Yak manifest Graves' ophthalmopathy

In 95% of cases, the cause of the defeat of soft tissues is a diffuse toxic goiter, which develops through thyrotoxicosis, when a thyroid gland is viral, there is an overwhelming amount of iodine hormones. Ophthalmopathy can manifest itself as soon as an hour becomes ill, so before you appear, or ten rock times after that. Mechanisms, through which retrobulbar fabrics are used, are unclear. Vvazhayutsya, which triggering factors are bacterial and rotavirus infection, intoxication to the body, radiation, stress, urgency, insolation.

Pathology is autoimmune in nature. This is the name of the camp, when the immunity starts to attack and improve the health of the tissue, taking it for the pathogenic cells. For one z version, immune system sprymak klitkovyu, yak otchu very yabluko, yak carrying receptors in iodine hormones thyroid gland... It’s because of an abnormal stun, and in order to solve the problem, immunity of the viral antibody for їkh domination.

Having penetrated into the fabric of the ochnytsi, the antibodies wicked away with infiltrate (purchased foreign particles). In the type of blood cells, the synthesis of glucose monoglycans is the speech that attracts the blood. As a result є a swelling of fabrics in the eyes and an increase in okorukhovyh muses, kistkovo basis ochnytsi.

Tse to produce up to exophthalmus - the substitution of a full-time apple ahead and appear vitreous. Inodі vono ide in bіk, a symptom of which is obliquity. By the same time, the verse is ignited, the infiltration will be transformed into the resulting fabric. A scar will form on the yogo mіsci, when a change appears.

It’s important to note the symptoms of pathology, and go to the endocrinologist to find out the main ailment. on cob stage Endocrine ophthalmopathy is not self-evident. In important cases, there may be a surgical involvement. It can be used for operations on tables, okorukh meats, decompression of orbits in case of exophthalmia.

early signs

Ophthalmopathy in thyrotoxicosis has a poor prognosis in lykuvannya: 10% of the patients are susceptible to polishing, in 60% - stabilization. For the reason, it is even more important to note the early signs of ill health. At the cob stage, pathology is manifested by the onset symptoms:

• "Pisok", receiving a vice in the organisor;
• tearing or dryness of the eyes;
• fear of fear;
• swelling near the organ zoru;
• not much vitreousness.

Stage of flaring key manifestations

In the world of development of endocrine ophthalmopathy, the situation is dying. Symptom of the c'yogo will become less common apples, ear blisters, swelling of pooches, doubled objects. Through those who have not built up their eyes until the end, they set themselves up in twists and turns on the horns, develop conjunctivitis and ideocyclitis - the fired arcades and veins. Dry eye syndrome often develops.

At the turn of the stage of endocrine ophthalmopathy, the healthy nerve atrophies, the collapse of the eyes is interrupted, through the internal grip the internal grip moves and pseudoglaucoma develops. It is possible to prevent occlusion (blockage) of the veins of the suture, which can lead to the loss of time. There is also a pathological process of getting rid of the body, the obliqueness does not develop very often.

Classification

There are few types of classifications of endocrine ophthalmopathy. Regarding the manifestation of symptoms, there are three stages of pathology:

• For the first step, a small vitreousness is characteristic, if the apple is in front of it, not more, less than 16 mm. Symptoms of the central stage are the congestion of the poop, without the destruction of the robotic mucus and conjunctiva.
• For another stage of endocrine ophthalmopathy, an 18 mm wide apple is characteristic. At this stage, a strong swell of povik, conjunctivi is promoted, periodically double in the eyes.
• The symptom of the third stage is the turn of the vitreousness: the forward visibility should be up to 21 mm. Illness can not rise to close eyes, on horns there are erosions, twists, very badly the apple is involved in decay, the healthy nerve atrophies.

The peculiarities of symptoms in the presence of the type of congestion

In medical practice, there are three forms of pathology - thyrotoxic exophthalmos, swollen form, endocrine myopathy. Symptoms of a number of different types of symptoms may appear, as you can see from the next table:

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Approximately 2% of the population is suffering from soft tissues of the eyes, which are tied to autoimmune inflammation of the thyroid gland. Symptoms can develop at once due to impaired synthesis of hormones, overdue dysfunction or failure after 3-7 years of severe remission, as well as due to uncommon visibility of the thyroid gland.

Thyrotoxicosis appears in 90% of patients with pathology, Alle, the production of hormones is normal. provocative factors: Viruses Infections; optimization, including ultraviolet radiation when sunbathing on the beaches or in solarium; kurnnya; contact with toxic speeches on virobnistvі; autoimmune control of loops, soft tissues; genetic strength.

For such infusions of cells of the immune system, they muddy and repair ruinous tissues and internal muses. Established in the form of half-heads stimulate the synthesis of words, as they absorb water in the tissues. Tsі to bring up to the blockage of a cellar behind a full-time apple. At the stage of the change of werewolves... To repair the germination of more fabrics with fibers each year with good fabrics from nezvorotnіm vipinnyam eyes, accelerated viglyadі vyglyadny zoru, vyrazok rogіvki, grave glaucoma.

Signs of the symptoms of pathology at an early stage: tearing; seeing a squeak in the eyes; dryness is increased; bіl when looking at the dzherelo of the bright light; napryaki pіd ochima.

The stage is flashed to be characterized by one-sided, for not symmetrical reservations in front of an intramural apple (exophthalmus). Symptoms: swelling of the swelling, swelling does not change in fallowness during the hour of the nutritional regimen; vipinnya vipinnya full-time apples; head b_l; the ear of the eyes; two items; unwillingly to rise to the wind.

produce up to burning of conjunctiva of the eyes, ridge, corrugation, xerophthalmia (dryness of the eyes). Nabryak tissue heal the nerve, which can lead to a decrease in the gap, the development of grave glaucoma, blockage of the veins of the bloodstream, obliquity.

thyrotoxic, swelling, myopathic.

Diagnostics of pathology: an examination of the oculist and endocrinologist, blood analysis, ultrasound examination, biopsies, post-mortem examination, poliv, function of the eyes; vimir of the magnitude of vipinnya, looking at the face-to-face bottom, biomicroscopy of the intramural middle, tonometry, MRI and CT.

Treatment of endocrine ophthalmopathy:

Read the report in our statute about endocrine ophthalmopathy, pathology pathology and medical recommendations.

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The reasons, including the appearance of the thyroid gland

Approximately 2% of the population is suffering from soft tissues of the eyes, which are tied to autoimmune inflammation of the thyroid gland. Most often they see women, when they get sick at 10, 20, 40 and 60 years old. Symptoms can develop at once due to impaired synthesis of hormones, overdue dysfunction or failure after 3-7 years of severe remission, as well as due to an uncommon appearance of the thyroid gland.

Characteristically, in 90% of patients with a pathology, they develop, they develop a little and are low, normal hormone production. If the background camp is autoimmune thyroiditis, then the number of thyroid activity in the fallowing stage is seen.

Provocative factors of ophthalmopathy:

• viral infections;
• optimization, including ultraviolet radiation when sunbathing on the beaches or in solarium;
• kurnnya;
• contact with toxic speeches on virobnistvі;
• autoimmune reduction of loams, soft tissues, cuckold diabet 1 type;
• genetic strength.

For such infusions of cells of the immune system, they muddy and repair ruinous tissues and internal muses. Established in the form of half-rings (growth factors) stimulate the synthesis of words, which will absorb water in the tissues. Tsі to bring up to the blockage of a cellar behind a full-time apple. At the stage of the wolf werewolf.

Allow an hour to repair the sprouting of otochenny fabrics with fibers from the obtained fabrics, from the non-collapsible vipinannyam of the eyes, the accelerated viglyadі vypushennya zoru, vyrazok rogivka, gracious glaucoma.

The raised stage is characterized by one-sided or not symmetrical changes in front of an intramural apple (exophthalmos). Before symptoms in the whole period of ailment, the following should be reported:

• swelling of the swelling, swelling does not change in the fallowness from the hour to the nutritional regimen;
• vipinnya vipinnya full-time apples (persha feet up to 16 mm, another up to 20 mm, a third ponad 20);
• head b_l;
• the ear of the eyes;
• double contours of objects;
• unwillingly to rise to the wind.

In ailments, it can cause damage to the conjunctiva of the eyes, ridge, corrugation, xerophthalmia (dryness of the eyes). Tissue nabreak is a pressure nerve, which can be reduced to a decrease. Through the intercourse of the ruffs of the apples, the internal age of the development of grave glaucoma, blockage of the veins of the bloodstream will collapse. Exercise of okorukh m'yaz_viklikє skewness.

Classification of endocrine ophthalmopathy

The enlightenment is manifested in three forms of viglyad:

diagnostics of pathology

The ophthalmologist and endocrinologist are guilty of the ailing. I mean the following:

• analysis of blood for antibodies to tissue, level of thyroxine and triiodothyronine, thyroid-stimulating hormone hypophysis;
• UZD zalozi, when a university is detected, it is recommended to use a new item for a preschool education (biopsia);
• doslіdzhennya gosti zoru, polіv, functions of mujazіv eyes;
• vimir of the size of vipinnya (exophthalmometry), kuta vidhilennya with oblique bone;
• looking around the face-to-face bottom;
• biomicroscopy of intramural middlings;
• tonometry (viznachennya internal vise) for glaucoma;
• MRI and CT for differential diagnosis of fluff.

An important knowledge є the destruction of the robotic immune system is the decrease in T-lymphocytes, the growth of antibodies: antinuclear, to thyroglobulin, tissue peroxidase, eye mucosa, coloidal speech of the thyroid cavity. Even if it is not in the performance of diagnostics, it is recognized that there is a biopsy in the eyes.

Treatment of endocrine ophthalmopathy

Vibir to the method of treatment to lay down the stage of ailments, the nature of the hormonal activity (hyperthyroidism, hypothyroidism,).

Pulse therapy

So, as it can be considered autoimmune, the most important method is the intake of hormones from a group of glucocorticoids (Metipred, Prednizolone, Dexamethasone). Smell nadayut over-the-top performance of anti-til, change the fill and fiery. The drugs are taken in the middle, carry out ін'єкції, before injecting an apple.

In case of a threat of sloughing, pulse therapy by Metipred is indicated. Vona transferє for over-high doses in a short course. At the day of the patient, wash 1000 mg of the drug for 5 days internally. It was established by the last few days that if you inject 1 g of methylprednizolone once a day, then the efficiency of the drug does not decrease, but the rizik side effects(Vyrazki the slunk і 12-gut, hypertension, thrombophlebitis) change.

Glucocorticoids are contraindicated in case of aggravated viral ailments, state of pancreatitis The destruction of blood, the presence of puffin abo psychotic... Such patients are recommended to optimize the tissues of the eyes with X-ray exchanges, purify the blood for additional plasmapheresis, cryoapheresis, and immuno-that hemosorption.

drug therapy

for korektsії hormonal damage stagnate Mercazolil, Espa-carb with overwhelming production of thyroid hormones (thyrotoxicosis) and Eutirox, with low activity (). Likuvannya is carried out until the normal synthesis is reached - euthyroid. If you don’t give in to help medicine, then you see a prickle, and a sick person will use hormones to replace the ingested function.

For normalization of the tissue readings Actovegin, Solcoseryl for intramuscular gel, inn'ktsiy and tablets. To polishit the robot okorukhovyh mu'yaziv to inject Prozerin. Renewal of the thickness of the shells and before the establishment of twisting defects, dryness, add vitamins A and E. dehydrated preparations (Lidase, aloe extract, enzymes) are also used for electrophoresis.

Learn the techniques, which do not stick to the main ones, but for some ailments they reject the results. With the combined sign of Trental and nikotinamid, the progress of ophthalmopathy for the development of galvanizing mucopolysaccharides, as well as water in the near-eye cells, will be trapped. Somatostatin analogs (Lanreotid and Octreotid) block the activity of one of the growth factors, which stimulate exophthalmos.

Hirurgic operation

There are three methods to choose from for patients:

• orbitotomy - one can see one stage of the orbit of eyes and cells. Tse additional help zbіlshiti obsyag ochnitsі. It is indicated for signs of nerve clenching, swiveling of the eyes;
• Correction of full-time muses is carried out with ailments, double vision, oblique bones, so as not to stick out with special eyepieces;
• plastic povіk is indicated when screwing up rugous parts, spasms, cramping sl_znykh zoloz.

folk methods

Acquaintance is made to autoimmune, so that the drugs in short times do not produce an effect, but in the greatest amount of evidence of the progress of symptoms. Folk methods of treatment can be brought up to the next hour. In such vipadkah werewolf eyesight change on the pathology. When the form of ailment is started, it is necessary to take active hormonal therapy and surgical engagement I will not increase Ophthalmopathy.

Poshkojennya eyes with a tsomu zhvoryuvannі є second camp. The cause of ophthalmopathy is in the robotic thyroid gland and in the immune system and in the organism. Likuvannya cich porushenia can only be done for additional hormonal therapy, surgery and optimization.

The earlier the disease has been detected, the greater the chances of improvement and renewal of growth. It is recommended that in case of healthy discomfort on the appearance of an increase in the thyroid gland, an accelerated heart rate, high energy, pain in the heart, it is safe to turn up to the oculist and endocrinologist, I will start to undergo a course of alcoholism.

It is important to vrahovuvati, whether it be a self-cleaning, storing medicines and supplements without any prior care and recommendation of a doctor, you can bring about an acceleration. Yakscho for a number chinnikіv Je rіznі Dumka s drive vplivu on rozvitok hvorobi then kurіnnya viznaєtsya dostovіrnoyu cause of vazhkih forms patologії.

Do not expect effective results in kurtsіv operatively. Vidmova see nikotin vazhaєya obov'yazkovuyu mind for patients.

Marvel at the video about endocrine ophthalmopathy:

Endocrine ophthalmopathy and vaginism

In general, the manifestation of thyrotoxicosis and ophthalmopathy is a factor that leads to an important interruption of vaginosity. Ale at the children of the progressing ailments develop through those who have immunity at the whole period of time. The most frequent symptoms of this are the enhancement of glare of the eyes, exophthalmus, shortness of mind and darkening of the head. Before going down to the level of degradation of thyroid hormone education.

An important non-lethargic thyrotoxicosis, high antibodies to thyroid glands є are indicated for fixing a child. It is linked with this, that antibodies and hormones from the mother penetrate through the placenta and children develop with the development of thyrotoxicosis.

If the woman still has a plan to continue her vaginism, then she will recognize the preparations with a gallowing effect, often propitious, which in the minor world penetrates through the uterine-placental bar. Indication of sedative drugs on the basis of roslinny (infusion of pustular and valerian) for reducing the damage of the heart and the robotic nervous system.

Endocrine ophthalmopathy - the whole tissue of the orbital of the eyes and the outer shells with ailments of the thyroid gland. The main reason for the development is the establishment of antibodies to vlastnykh cells. It is characterized by exophthalmos, collapsed eyes, difficulties in the flow of intramural age, twins, increased internal vise, decreased vision.

To make a diagnosis, ophthalmologic and endocrinologic procedures are performed. Shown is an intensive drug therapy, in case of ineffectiveness - visualization and correction of surgery.

Endocrine ophthalmopathy - the tse of becoming ill, when you see an increase in the soft tissues of the eye, which develops through the pathology of the thyroid gland. Endocrine ophthalmopathy occurs in the main exophthalmos and swelling from the fiery tissues of the eye. For the diagnosis of endocrine ophthalmopathy, it is necessary to carry out such conditions as exophthalmometry, biomicroscopy and CT of the orbit. Tests on the camp of the immune system are also carried out.

Endocrine ophthalmopathy can occur during the first autoimmune processes in the thyroid gland.

Well, I’ll provoke ophthalmopathy so it’s not clear until the end. Ale in the main start-up for the development of є taki factori, yak respiratory infectionsі cure, radioactivity in small doses і salt important metals Also, stress and autoimmune disease is a type of diabetes. Losing form of endocrine ophthalmopathy occurs most often in young people, but the important form is typical for people with a kidney disease.

It should be noted that when T-lymphocytes mutation, they repair the interaction with the receptors of the membranes of the cells of the mucous membranes, provoke in them the establishment of specific changes. Autoimmune reactions of T-lymphocytes provoke the vivification of cytokines, stench into one's own heart, induce the proliferation of fibroblasts, viroblast collagen and glycosaminoglycans. Vibrating glycosaminoglycans will make the fillings when the water is ringing and when you get rid of the ratrobulbar klitkovini. Such a load of fabrics orbits will change for an hour, and then bring exophthalmus into the bag to the point where the process is nonvolatile.

With the development of endocrine ophthalmopathy, several phases of ignition exudation, infiltration and phase proliferation and fibrosis are promoted.

There are also three stages of endocrine ophthalmopathy: thyrotoxic exophthalmos, nodular exophthalmos and endocrine myopathy. The report is easy to see.

Thyrotoxic exophthalmos

Thyrotoxic exophthalmus is characterized by a true or gracious protrusion of a full-time apple, as well as the appearance of a table when the eyes are lowered and the blisky is lowered.

nabryakly exophthalmos

Nabryaklium exophthalmos manifests itself with a swollen vystoyaniya intramural apple by two to three centimeters and a double-sided embryo periorbital tissue. It is also possible to see the crumbling fall of the apples. In the future, the progression of endocrine ophthalmopathy with general ophthalmoplegia and lack of micronisation of the skin lines, with twisted horns - a process that passes through the corneal shell of the eye at once to reveal a crater-like defect. Against the backdrop of dimness and dimness.

endocrine form

The endocrine form of myopathy is most often the most straightforward of myopathy, and in the bag it can be brought to the diplopia, because it is called the visibility of the eyes, skewness.

To determine the variability of ophthalmopathy, use the table of the Baranov step, and for the first step, the following criteria will be required:

• little exophthalmos;
• small swelling of the capital;
• intactness of conjunctival tissues;
• not ruined myazova the ruffleness of the eyes.

For another step of the isnu, the characteristic is:

• the turn of the exophthalmus is gone;
• the rise of the capital is signi fi cantly improved, at the porch with the first step;
• the manifestation of conjunctival swelling.

The third stage of endocrine ophthalmopathy appears to develop from two anterior stages of the brain, as a result of diplopia and corners of the horn, which also occurs atrophy of the healthy nerve, with a sudden onset of nerve development. Such an atrophy of the intramural nerve will provoke a loss of vision.

symptoms of ophthalmopathy

Early clinical manifestations of ophthalmopathy are characterized by a drooping grip in the os, dryness, or navpaki lacrimation, apparent uncommon views from the bright light, as well as the periorbital area of ​​the eye. Exophthalmus develops in maybut, the appearance of which splicing is asymmetric or one-to-one development.

During the period, there are already clear manifestations of the clinical symptoms of endocrine ophthalmopathy, there are signs of an improvement in apples, a swelling of the headache, and also a severe swelling of headaches. Likewise, in case of an uncommon state of affairs, there are no signs of flare-ups and conjunctivitis.

Yaskravo bends of the exophthalmos to produce up to the inception of the compression of the healthy nerve and the subtle atrophy. Also exophthalmos in the presence of endocrine ophthalmopathy in the diagnosis of a greater clarification and determination of the characteristics of the other types of pseudoexophthalmos;

With the uncomfortable crumbling of the apples, the grip of the middle of the eye and the development of pseudoglaucoma persists.

In diagnostics, especially, albeit not even one and smut, the value of a suppurative diffuse toxic goiter. With the presence of a characteristic bilateral process in the patient, it is practical to immediately start a diagnosis. Ridko to be brought to vikoristovuvati ultrasound dosage for viznachennya tovshchini okorukhovyh mu'az_v.

For a number of types of diseases, a follow-up is carried out for active diagnostics of clinically unaffected endocrine ophthalmopathy, which allows for the development of toxic goiter in quiet cases, if there is a folding of the disease. Likewise, the function is not carried out by the MRI method, it is the most informative analysis in this vypadku. The main reason for given doslіdzhennya- it is shown in a sick one-sided exophthalmos, for a disease of retrobulbar swelling.

When diagnosing diabetic ophthalmopathy, it is important to establish the activity of endocrine ophthalmopathy for an additional clinical picture in front of the signs of the disease. For the whole basic scale of clinical activity from one to seven points:

Endocrine ophthalmopathy behind such a scale is actively involved in the chotiroh bali.

Treatment is carried out spirally with an ophthalmologist and an endocrinologist during important stages of incapacitation and defects in the robotic function of the thyroid gland. The success of the policy is being transformed to the achievements of the steadfast euthyroid camp.

Nespriyatlivo vplivaє on perebіg endokrinnoї oftalmopatії gіpotireoz i thyrotoxicosis, takozh pogіrshennya will fіksuєtsya at dosit Shvidky perehodі od one to іnshogo mill, to pіslya zastosuvannya operative lіkuvannya, Varto chіtko kontrolyuvati rіven tireoїdnih gormonіv in krovі, slіd provoditi profіlaktichnі meri according to vіdnoshennyu gіpotireozu.

Features of the treatment of endocrine ophthalmopathy

Quite often key picture Endocrine ophthalmopathy is susceptible to occur in patients without major lesions of robotic thyroid disease. In such ailments, when there is a complete possibility of developing subclinical thyrotoxicosis or subclinical hypothyroidism, the appearance of pathological symptoms is also possible. When there are any pathological changes, it is indicated that a sample is taken with thyroliberin. Many ailments are diagnosed by a doctor-endocrinologist, who undergo dynamic control of thyroid status.

In case of recognition, there is also a sense of intelligence, so that the power of the momentary remission can be taken over. Likuvannya is also a sign of seriousness and activity.

Yake lіkuvannya transferred for the young stages of becoming ill

If there is a grave illness, it is necessary to pinch the curtain and seize the horns for the additional speck, to wear darkened eyepieces.

Active therapy in a large number of their vipads does not stagnate with endocrine ophthalmopathy, so as I can get sick easy shape and quicker to natural remission, right from the start. Ale all the same patsієntovi varto dotrimuvatisya deyak rules, for example, pinch the courtyard and vikorystannya full-time speck.

It is necessary for lykuvannya

The main reason for remission is for euthyroidism. At the end of the severe stage of endocrine ophthalmopathy, the pulse therapy with methylprednizolone is often stagnant, which is the most effective and most unhealthy method. Prototype indications until the pulse therapy is stopped can be used for the twisting ailment of the shlunk or two-fingered intestines, Pancreatitis and arterial hypertension.

So it is stagnant to take oral administration of pre-nizolone, ale this way of making a great risk of winning vicious effects. To reach a frequent problem in case of ingestion of glucocorticoids - recurrence of endocrine ophthalmopathy often develops after taking medications.

Promeneva therapy

Promeneva therapy is indicated for people with diagnoses of endocrine ophthalmopathy in the presence of both important stages of ignition symptoms, diplopathy and general loss. Radioactivity is the power of ruining orbital fibroblasts and lymphocytes. For a necessary reaction to receive the radioactivity, it will take a couple of requests. At the end of the period, the ignition process is gaining wraps. With a hand of the first few types of people, a large part of people from such disabilities are encouraged to get help from steroids. Finding the reaction to the exchange therapy of the winery in patients at the start of the ignition process. Stagnation of radioactivity can give a shorter effect in the course of additional steroid therapy.

Iakshcho vrahovuvati the fact that storing exchange therapy can be infused into the field of the camp with malfunctions of robotic motor skills, for the treatment of diplopia stagnation of imbalance, as one type of treatment, does not appear. Orbital irradiation in endocrine ophthalmopathy is developed by the safest method of treatment. Oppression is not recognized by people with diabetic diabetes through the possibility of reducing retinopathy.

X-ray therapy

Likewise, along with the use of other drugs, the method of X-ray therapy on the orbital area with synchronous glucocorticoid intake. X-ray therapy is stagnant in case of clearly visible edematous exophthalmia, in case of ineffective treatment with glucocorticoids alone, it is carried out remotely to optimize the orbits from straight and field fields due to the closure of the anterior field of the eye.

X-ray therapy can induce anti-inflammatory and antiproliferative activity, provoking a decrease in cytokines and secretory activity of fibroblasts. The effectiveness of X-ray therapy is assessed by the end of two months of treatment. An important form of endocrine ophthalmopathy is the transmission of surgical treatment for orbit decompression. Surgical treatment stagnates at the stage of fibrosis.

There are also three types of surgical treatment, including:

• operations on the arms when the arms are severe;
• coriguyuchiy operuvannya on rukhovy eyes, carried out with the presence of oblique bones;
• surgical decompression of the orbits, as it stagnates for the weakening of the healthy nerve.

In case of a small retraction of the capital with the renewal of an euthyroid stance, it is possible to quickly determine the improvement of the capital. Also, the involvement of a change in the positioning of the horn is carried out for the reduction of proptosis from an easy stage to a small form. For patients who do not lose the power in the operability of the capital, replace hirurgic path the upper line, consuming botulinum toxin and subconjunctival triamcinolone in the upper line.

Lateral tarsoraphia changes the upper and lower retraction of the capital, such is the operation of the man, as well as the cosmetic results and the stability of the better.

The lowering of the upper povika trap for the rakhunok of the dosed tenotomy of the levator.

It can also become stagnant in case of inactive phase of endocrine ophthalmopathy in case of healthy and cosmetic damage. One of the most effective therapy is to get involved in the exchange of glucocorticoids.

Forecast for endocrine ophthalmopathy

Only two large patients develop an important form of interruption of endocrine ophthalmopathy, which can lead to serious acceleration. At the current stage, medicine is at such a level, with the help of some additional help to seek a serious remission and to get by without the important inheritance of ailments.

procedure stagnate
when ill Endocrine ophthalmopathy

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Endocrine ophthalmopathy is a disease, sometimes also called Graves' ophthalmopathy, autoimmune or thyroid ophthalmopathy, thyroid-associated orbitopathy, malignant exophthalmos.

The changes of the soft tissues (mucus, fatty cells and others) through the specific autoimmune inflammation lead to the development of exophthalmus (the mill, when the apple is very weak, it seems to be more dull) and ... Tsya ophthalmopathy, which is the result of endocrine pathology, vimagal lykuvannya spilno at the endocrinologist and ophthalmologist.

wideness

Spіvіdnoshennya between men and women, uteri endocrine ophthalmopathy (EOP), for the given dzherel become in the middle 1: 5-8. Pathology is practical to develop in any business. There is a clear peak of seizure seizure on people over forty and sixty, as well as on adolescents. Є Communication between every manifestation and overcoming ailment: in young people, endocrine ophthalmopathy can be easily countered, and it can appear important.

cause development

If exophthalmus was first described in 1776 by K. Graves, its development was associated with a pathological thyroid gland. In 80-90% of cases, ophthalmopathy develops on the same hyperfunction (advanced function) of the organ. However, a third of the patients became ill with those who have hypothyroidism or hypothyroidism (normal / decreased function).

In addition, the development of exophthalmos may not be associated with the manifestation of pathology of the thyroid gland: the symptoms may appear as a backward to the development of hyperthyroidism, so there is a lot of growth in order to diagnose the disease (up to 20). And in 10% of cases, the pathology of the thyroid gland in the back is not discouraged.

What can you explain? It remains an hour taken to respect that the cause of endocrine ophthalmopathy is the appearance in the tissues of the orbital of antigens, which cause pathological autoimmune inflammation. Moreover, the elements of antigens are similar to those of the antigens of the thyroid gland. In any case, the fabric is simply spilno react with the development of the ignition process.

By the same token, it’s a matter of fact that the normalization of the function is not expected to lead to exophthalmus regression. In order to navigate the background of euthyroidism, the problem will become less twisted, or all one will be lost.

In the literature, there are clues about the development of endocrine ophthalmopathy with myasthenia, vitiligo, pernicious anemia, Addison's ailment. Factors that increase the rate of illness:

• Transfer of infections (retroviral, yersiniosis and in.);
• Any talk is toxic;
• Ionizuyuche vipprominuvannya;
• Chronic stress;
• Kurinnya.

development mechanism

To transfer, from the start-up officials of the fibroblast (cells of the fibroblast), smooth cells of cells and cells of the fat cells in the retrobulbar area, to repair the specific child antibiotics on their surface. Smells are recognized as defective clones of T-lymphocytes, which massively multiply in response to the presence of autoantibodies.

Infiltration of tissue orbital tissue with increased vividness by lymphocytes and macrophages of cytokines and other specific fluxins should be produced until the synthesis of cells from the resulting tissue of glucosamines is stimulated. Remain in the complex with proteoglycans to tie water and produce fabrics to fill. Obsyag m'yazіv and klіtkovini zbіlshuєtsya, by the very same "vishtovkuyuchi" called ogni apples. Moreover, the development of endocrine ophthalmopathy can be asymmetric.

Damaged tissue can help the healthy nerve, which can lead to damage (development of compression neuropathy). Nabrekli m'yazi can not visonuvat its function, so often it is difficult to collapse of the eyes or to develop obliqueness. With a severely swollen exophthalmia, you may not turn your eyes closed, it does not snake the tears on the surface of the horn, you can visihati and pozhkozhuvatisya (developing keratopathy).

Through the splinter of rock on the change of the embankment, the growth of the full fabric comes. As luck would have it, success is not enough, the snakes in the tissues of the orbit are becoming unvarying.

show

Symptoms of endocrine ophthalmopathy lie in the form of a rosy disease, there are three:

diagnostics

Also, endocrine ophthalmopathy develops quickly, and symptoms appear with an acute eye, immediately sponk the drug for diagnosis. Besides the standard ophthalmologic dosages (a look at optical centers, visometries, perimetry, and a convergence view of a full-time day), you can know the data of ultrasound or MRI / CT. According to the results, the narrowing of the body becomes more widespread and the nature of the tissue orbital, the steps of the expansion of the retrobulbar space.

For the measurement of certain indicators of exophthalmus, the Hertel exophthalmometer. And schob assess the progress / regression of the disease, the car can create a photo.

In case of symptoms of thyroid dysfunction, prescribe an analysis for T4 / T3 levels, as well as TSH, antibodies to thyroid tissue, and ultrasound diagnostics. In order to clarify the nature of the test, immunological indicators can be seen.

Classification

For the foreign classifications of NOSPECS, є 7 classes of progressive endocrine ophthalmopathy (from 0 to 6), 2-6 classes may show (0-a-b-c), when I can see the steps of an exponential loss. Skin letters in the name of the classification indicate a symptom:

• N (speed. Від no signs / symptoms) - the prevalence of symptoms;
• O (speed. Від only sings) - only retraction of the column;
• S (fast Vid soft-tissue involvement) - mill of soft-tissue involvement;
• P (speed Від proptosis) - value of exophthalmos;
• E (speed Від extraocular muscle involvement) - pathology of okorukhovyh muscles;
• C (speed. Від сorneal involvement) - pathology of the horn;
• S (speed Від sight loss) - decrease in zoru.

Before important ones, read 2 c, 3 b-c, 4 b-c, 5 0-c, 6 0-a. Up to the most important ones, 6 b-c.

At the edges of the SND, Baranov's classification was often victorious.

• Stage I: insignificant exophthalmos - 15.7-16.1 mm, small swelling, periodically seeing a "squeak", and not getting the message.
• Stage II: Exophthalmos average gravity- 17.7-18.1 mm, insignificant changes in stitching and misalignment, diplopia, sludge leakage, and the appearance of a “sip”.
• Stage III: exophthalmos is important - 21.1-23.3 mm, impaired function of the mucous membranes, the spine does not stagnate, diplopia, pathology of the corneal nerve.

principle of liking

Heads of points, which are guilty of vrahovuvatisya before the hour of treatment of endocrine ophthalmopathy - tse:

• Usunennya chinnik_v rizik;
• Pidtrimka euthyroidism;
• Zapobіgannya development of keratopathy.

For a wide variety of thyrostatic drugs, such as thyroxine (in the presence of a vychіdny camp), in important cases, thyrotoxicosis is visible to the organ. For prophylactic prophylaxis, picking up vicorist dots "piece slyozi", full-time gels.

conservatively

At the station of compensation and subcompensation of vicorist therapy with prenizolone, the principle of taking corticoids (dose, hourly, additional calcium preparations, antacid preparations). Even endocrine ophthalmopathy is in the stage of decompensation, the rate of pulse therapy is shown (by taking an adjustable dose of drugs for 3-5 days). When glucocorticoid is not effective, cytostatic drugs should be used. Vikoristannya retrobulbarnykh іn'єktsіy step by step grows through the development of side effects: traumatism of otchuyuchuyh tissues, growth of complete fabrics in the introduction of a pharmaceutical preparation.

For the improvement of the shortened effect, it is recommended to use the vikorystannya exchange therapy - an X-ray optimization of the area. Most people with sick and aggressive interruption of endocrine ophthalmopathy. To achieve often accelerated X-ray therapy is required: changing the reduction of the horn, the healthy nerve, and the retardation.

In the scheme of treatment, analogs of somatostatin are administered, the receptor is up to and including the dose, є in retrobulbar tissues. Vikoristannya cich preparations can be used to treat ailments.

Additional methods - plasmapheresis or intravenous administration of immunoglobulin - is still a lack of vaccination. Trivial accumulation of key material. Promising є retail biological preparations- rituximab, іnflіxіmaba and іnshikh. Їх vikorystannya theoretically more true, lower intake of steroid hormones.

surgical treatment

In case of failure of a conservative treatment, symptoms develop rapidly and may be known promptly. Decompression of the orbital (an increase in the debridement of the ochnitsa for rakhunok ruinous її stinok) will be necessary in case of a progressive deterioration of the healthy nerve, derangement of the intramural apple and іn. Іnshi vid of surgical treatment - plastic surgery of okorukhovyh muses and vіk - blame for the stagnation of the process, in order to solve individual problems.

In addition, if the results have been achieved, it is necessary to try and trivially be cautious of the endocrinologist and ophthalmologist for 3-6 months. In a third of the patients, there is an infusion of polypsy (regression of exophthalmus), in 10% - not very much progressing ailments. The ailments of the ailments will stabilize.

In order to learn more about the development of ailments, a lot of hto shukak forum, assignments to endocrine ophthalmopathy. As a memory, it’s just a real drug to assess changes in the body and in the need for a therapy regimen.

http://glazkakalmaz.ru

endocrine ophthalmopathy

Endocrine ophthalmopathy (thyroid ophthalmopathy, Graves' ophthalmopathy, autoimmune ophthalmopathy) is an autoimmune process that contradicts specific disorders of retrobulbar ophthalmopathy of the risky step bend. For the first time, bulo was described in detail by K. Graves in 1776.

Endocrine ophthalmopathy is a problem that is of key interest for endocrinology and ophthalmology. Endocrine ophthalmopathy suffers from about 2% of the total population, with the middle of women developing in 5-8 times more often, lower than the middle of the population. Vikova dynamism is characterized by two peaks of Manifestation of Graves' ophthalmopathy - in 40-45 years and 60-65 years. Endocrine ophthalmopathy can also develop in childish, More often among the women of the first and another ten years of life.

Causes of endocrine ophthalmopathy

Endocrine ophthalmopathy of vines on the primary autoimmune processes in the thyroid gland. Full-time symptoms can appear one hour at a time from a clump of a thyroid gland, overwhelming or developing in an extended term (in the middle after 3-8 years). Endocrine ophthalmopathy can be suprajuvati thyrotoxicosis (60-90%), hypothyroidism (0.8-15%), autoimmune thyroiditis (3.3%), euthyroid status (5.8-25%).

Factors, such as endocrine ophthalmopathy, have not yet been identified. In the role of triggering mechanisms, there may be respiratory infections, small doses of radioactivity, insolation, disease, salts of important metals, stress, autoimmune disease (specific diabetic disease), The association of endocrine ophthalmopathy with the antigens of the HLA-system has been identified: HLA-DR3, HLA-DR4, HLA-B8. M'yaki form of endocrine ophthalmopathy is often developed in the middle of a young person, an important form of envy is characteristic of people of a kidnapped person.

It is transmitted, after spontaneous mutations of T-lymphocytes, to repair interactions with the receptors of the membranes of cell membranes and to wick specific changes in them. Autoіmunnі reaktsії T i lіmfotsitіv klіtin-mіsheney suprovodzhuєtsya vivіlnennyam tsitokіnіv (іnterleykіnu, puhlin necrosis factor, γ-іnterferonu, transformuyuchogo growth factor b, trombotsitіv growth factor, growth factor іnsulіnopodіbny 1) SSMSC іndukuyut prolіferatsіyu fіbroblastіv, utvorennya kolagenu i viroblennya glіkozamіnoglіkanіv. Remain, in your own room, to drink the sound of water, to develop the curtain and to make the retrobulbar bloom. The increase and the infiltration of the tissue of the orbital changes in an hour to fibrosis, as a result of which the exophthalm becomes non-vortex.

Classification of endocrine ophthalmopathy

In the development of endocrine ophthalmopathy, there is a phase of ignition exudation, a phase of infiltration, which changes by the phase of proliferation and fibrosis.

Three forms of endocrine ophthalmopathy are seen in the urahuvannya of the prevalence of intramural symptoms: thyrotoxic exophthalmos, nodular exophthalmos and endocrine myopathy.

Thyrotoxic eczema is characterized by insignificant true abnormal protrusion of full-time apples, retraction of the upper vertebrae, visceral depression with drooping eyes, tremor of crying symptoms, glare of the eyes, lack of convergence.

Talk about edematous exophthalmia when full-time apples are 25-30 mm thick, swollen double-sided embryo periorbital tissue, diplopia, sparse crumbling of apple apples. Further, the progression of endocrine ophthalmopathy is accompanied by ophthalmoplegia, lack of moisture in the face, conjunctival chemosis, curving horns. congestive lesions on the day, pain in the orbit, venous stasis. V key interruption nabricheskogo exophthalmos see phases of compensation, subcompensation and decompensation.

In case of endocrine myopathy, there is a weakness of some of the straight gory mucus, which can lead to diplopia, the unhappiness of bringing the eyes, such as burns, oblique bones. vidhilennya full-time apple to the bottom. In addition to the hypertrophy of the gory mucus, there is a progressive build-up of collagen degeneration.

For the development of the variability of endocrine ophthalmopathy in Russia, call for the classification of V.G. Baranov, since it sees 3 stages of endocrine ophthalmopathy.

To serve as the criteria for endocrine ophthalmopathy of the 1st stage: movable exophthalmos (15.9 mm), no more swelling of vik. The tissue of the conjunctiva is not damaged during the whole intact, the function of the okorukhovyh muses is not damaged.

Endocrine ophthalmopathy of the 2nd stage is characterized by an abdominal exophthalmos (17.9 mm), a significant swelling, a swollen conjunctival swelling, periodic twins.

In grade 3 endocrine ophthalmopathy, there are signs of exophthalmos (20.8 mm or more), diplopia of a persistent character, unpleasantness of repeated swelling of the swelling of the horns, signs of atrophy of the healthy nerve.

Symptoms of endocrine ophthalmopathy

Until the early clinical manifestations of endocrine ophthalmopathy, the past appears to be a "squeak" and a squeeze in the eyes, tearing or dryness of the eyes, fear, swelling of the periorbital region. It is necessary to develop exophthalmos, which is often asymmetric or one-sided in nature.

At the stage, key manifestations the named symptoms of endocrine ophthalmopathy become permanent; before them, it is possible to see the increase in the appearance of full-time apples, in the conjunctiva and sclera, swelling of the swelling, diplopia, head bile. The inability of a recurrent malady to induce the development of conjunctivitis and iridocyclitis before the approval of the corrugation. The fiery infiltration of the slushy zolozi is susceptible to dry eye syndrome.

In case of severe exophthalmia, there can be a compression of the healthy nerve, which can lead to atrophy. Exophthalmos with endocrine ophthalmopathy followed by differentiation from pseudoexophthalmos, which is more susceptible to a high degree of short age. orbital celulitis (phlegmon), puffins (hemangiomas and orbital sarcomas, meningiomy and in.).

The mechanic of the crumbling of the apples of the apples to produce the internal vice and development, so called, pseudoglaucoma; in some cases, the occlusion of the veins of the embryo develops. Achievement of full-time musings is not easy to supervise the development of oblique bones.

Diagnosis of endocrine ophthalmopathy

Diagnostic algorithm for endocrine ophthalmopathy, transmission of a patient by an endocrinologist and ophthalmologist with a set of instrumental and laboratory procedures.

Endocrinology is aimed at clarifying the function of the thyroid gland and including the development of thyroid hormones (vilny T4 and T3), antibodies to the tissue of the thyroid gland (Anti to thyroid globulin and Ati to thyroid perioxy). In the development of universities in the thyroid zone with a diameter of more than 1 cm, the display of the puncture biopsies is shown.

Ophthalmologic treatment for endocrine ophthalmopathy healthy functions and visualization of orbital structures. The functional block includes visometry. perimeter. improved convergence. Electrophysiological dosage. Biometric dosage of the eye (exophthalmometry. Vimir kuta oblique bones) allow the visibility of the visibility and the steps of seeing the apples.

For vyklyuchennya development of neuropathy of the healthy nerve, an examination of the intramural bottom is carried out (ophthalmoscopy); from the assessment of the structure of the och - biomicroscopic; for the detection of internal hypertension, tonometry is displayed. Methods of visualization (ultrasound, CT, MRI of orbits) allow differentiation of endocrine ophthalmopathy from retrobulbar corticosteroids.

With endocrine ophthalmopathy, it is superbly important є the improvement of the immune system of the sick person. The snake of the clergy humoral immunity with endocrine ophthalmopathy, it is characterized by a decrease in the number of CD3 + T-lymphocytes, a decrease in the number of CD3 + lymphocytes, a decrease in the number of CD8 + T-synpeccopes; growth of the level of IgG. antinuclear antibodies; adjusting the titer of Ab to TG, TPO, AMAb (full-time m'yazam), other coloidal antigen. For the witnesses, the biopsies of the battle of the okorukh muzyaz will be displayed.

Treatment of endocrine ophthalmopathy

A practical tactic is to begin with the stage of endocrine ophthalmopathy, the stage of impairment of the function of the thyroid gland and the turnover of pathological changes. All the options are straightforward to reach the euthyroid camp.

Pathogenetic immunosuppressive therapy of endocrine ophthalmopathy includes the sign of glucocorticoids (prednisolone), immunosuppressive action... Corticosteroids tend to become stagnant in the middle of the viglyadi of retro-bulbaric ones. In case of a threat at a loss, pulse therapy with methylprednizolone, orbital X-ray therapy is performed. Vikoristannya glucocorticoids is contraindicated in cases of acute ailments of the slunk or two-fingered intestines. pancreatitis. thrombophlebitis. arterial hypertension... destruction of blood, mental and oncological illnesses. Plasmapheresis can be used as methods for additional immunosuppressive therapy. hemosorption. immunosorption. cryoapheresis.

If the function of the thyroid gland is impaired, the correction of thyrostatics (with thyrotoxicosis) or thyroid hormones (with hypothyroidism) is carried out. If the stabilization of the function of the thyroid gland is uncomfortable, you can visit the thyroid dectomy with the help of HRT.

Symptomatic therapy for endocrine ophthalmopathy is directed to the normalization of metabolic processes in tissues and nerve-muscle transmission. At the same time, it is recognized that the actovegin, proserin, and styling clippings are used. pledging ointments and gels, taking vitamins A and E. Three methods of physiotherapy for endocrine ophthalmopathy are electrophysiologic electrophoresis with lidase or aloe, magneto therapy on the orbital area.

more surgical treatment Endocrine ophthalmopathy includes three types of ophthalmologic surgeries: decompression of the orbit, surgeries on ophthalmological organs, surgeries on headbands. Decompression of the orbital is straightforward for an increased amount of ossification and is indicated for progressive neuropathy of the green nerve, severe exophthalmia, twisting of the horns, podvivih of the intramural apple and in. Situations. Decompression of the orbit (orbitotomy) can be reached by the way of resection of one or more decile stems, as seen by retrobulbar cells.

Operational involvement on okorukhovy m'yaz is indicated for the development of a stiff sore diplopia, paralytic oblique bone, if it is not possible to go through prismatic glasses.

Operations on the turns to become a large group of flexible plastic and functional ones.

Forecast of endocrine ophthalmopathy

In 1-2% of patients, a particularly severe overload of endocrine ophthalmopathy is observed, which can lead to important healthy ones in an accelerated state. In a day-to-day medical practice, it is permissible to seek an induced remission and to identify important inheritances of ailing. The result of the therapy in 30% of the ailing is to serve as clinically ill, in 60% of the stabilization of the endocrine ophthalmopathy, in 10% of the progression of the disease.

Endocrine ophthalmopathy - treatment in Moscow

Endocrine ophthalmopathy or EOP is an ophthalmologic disease, tied to the lesions of internal muscular tissue and tissue. Pathology develops through autoimmune ailments of the thyroid gland and nagato grows as a result of thyroiditis or ailments.

Endocrine ophthalmopathy is more severe in women in the age of 40-45 and 60-65 years. Ale inode ailment diagnose in children younger than 15 years. The children become ill 5-8 times older. In a young person, endocrine ophthalmopathy can be easily tolerated by patients, for every day of the lives of people who suffer from important forms of discomfort.

The reason for the development of pathology є autoimmune reactions, with such immune system repair, Viroblyaє specific antibodies, such as step by step tune the internal structures, vyklikayuchi zapalennya.

For that, as the igniting processes subside, the health of the fabrics and repairs change completely. After a couple of rockets, a scar will form and (vitreousness) will last for all life.

Endocrine ophthalmopathy is most often diagnosed in people who may have such pathologies in their history of ailments:

• hypothyroidism;
• thyrotoxicosis;
• thyroid cancer;
• Diabetes mellitus;
• Hashimoto's thyroiditis.

15% of people do not have a damaged thyroid gland. I have a lot of problems with getting sick, viral infection, Kurnnya, stress, radioactive injection.

symptoms

Endocrine ophthalmopathy is an important pathology of autoimmune nature. It is important to find out the symptoms and consult an endocrinologist and ophthalmologist for an hourly treatment. There is an early and early manifestation of endocrine ophthalmopathy.

A lot of illnesses are manifested by offensive signs:

• photophobia (fear of light);
• seeing a squeak in the eyes;
• uncontrolled leakage.

At the onset of the stage of flared up symptoms, diplopia (double image) is indicated, the swelling of the symptoms, lack of muscle growth, development, headaches, hyperpigmentation, symptoms of the disease on the basis of symptoms,

For endocrine ophthalmopathy, I am familiar with є exophthalmos, which manifests itself in strong vipinnym of full-time apples. People cannot get stuck up, as a result of which they develop, which become chronic, dry eyes, twisted horns.

Zakvoryuvannya to produce up to the level of the mucous membrane of the bottom, through which the internal vice moves, thrombosis of the veins of the suture develops, oblique bone appears.

Classification and steps

Inferiority of the classification in fallowness will show signs and symptoms. Russia has a classification for V.G. Baranov. The special features are shown in the tables

Classification according to Brovkin

It is common practice to use endocrine ophthalmopathy in 3 stages, skin diseases are characterized by their own signs.

Thyrotoxic exophthalmus is superfluous to small tremors, if the stench is closed, when the eyes are lowered. As pathology quickly progresses, then myopia develops, dual images of objects appear. Symptoms are mainly characteristic of people who suffer from thyroid hypothyroidism. Gradually come to vitriol, ale the clumpiness of the blood, not to be spared, to protest the general muses.

Ophthalmopathy is caused by bilateral lesions of organs. A number of symptoms are spared on one point, and then, with a handful of decliners, the enemy becomes ill and another eye.

Qia form to go through 3 stages:

1. Compensation. To fix for dropping the capital from the wound. Closer to evening, the camp will begin to grow. In the world of progresuvannya ailment sposterіgaєtinja to increase the tone of the internal musings, the internal schіlina to expand.
2. Subcompensation. Tsei period zvoryuvannya supervodzhutsya zbіlshennya full-time vise, exophthalmus, with a lot of fabric, but not tied because of the heat, on the lower table there is chemosis. Symptoms of vitreousness grow even more quickly, the symptoms cannot close up, other sclera sclera branch out and little ones appear at the spine.
3. Decompensation. The eye of the old napryaklka will become full, but it is practical not to collapse. If you don’t try to get sick, you’ll think of atrophy of nerve fibers, it’s molding.

Endocrine myopathy is characterized by weakness of okorukhovyh mu'yazyv, oblique.

diagnostics

In order to correctly diagnose the diagnosis, it is necessary to consult an endocrinologist, an ophthalmologist. Endocrinologist to designate ultrasound scan of thyroid gland for detection of health and universities. As soon as there will be great universities, they will conduct a biopsy on the basis of the onset of the materials taken for the histology. Also for assessment correct robots Thyroid glands of the patient is given an analysis for hormones and the presence of antibodies to tissues.

Ophthalmologic diagnostics includes:

• visometry (visibility of readability);
• assessment of the health of the apples collapsed;
• perimeter (detection of cordons of the green field);
• face-to-face reversal;
• vimіryuvannya vise in the middle of the eye;
• biomicroscopic examination for the assessment of the mill of the largest internal structures.

Differential diagnosis

Differential diagnostics is necessary in order to detect new conditions, miastenia, pseudoexophthalmos with a high degree of short growth, as the symptomatology may be similar. For differential diagnostics, it is recognized: ultrasound, CT, MRI, blood monitoring for additional immunograms.

For carrying out differential diagnostics and confirmation of diagnostics, the activity of the disease begins on the CAS scale. Have a patient who has the following symptoms:

• swelling vіk;
• pochevoninnya conjunctivi and nabryak (chemosis);
• b_l when trying to translate a look;
• swelling of lacrimal meat (karunkuli);
• pochvonіnnya povіk.

For skin podverdzhenii symptom is awarded 1 point. It’s like a symptom is not susceptible to, it means being ill in an inactive phase. With the presence of 7, the sign of endocrine ophthalmopathy is seen as a bend. We are active in getting sick if the number of symptoms is more than 4.

Treatment of endocrine ophthalmopathy

Likuvalny tactics will be picked up by a drug in fallowness in the level of activity of ailments and її form.

Therapy goals є:

• conjunctival disorders;
• normalization of a full-time vice;
• stabilization, for the weakening of ruinous processes in the middle of the eye.

Correction of the thyroid gland is performed by an endocrinologist. In case of hypothyroidism, thyroxine is used, in case of hyperthyroidism, thyrostatics are used. As soon as taking medications doesn’t bring a proper result, it’s impossible to get rid of it quickly enough to see the whole "thyroid gland" or part of it.

The binding component of the drug process is steroids (Methylprednizolone, Kenalog). For the help of glucocorticoids, they absorb fatness, heat, bring immunity. Often with endocrine ophthalmopathy, Cyclosporine (immunodepressant) is prescribed. Yogo prescribe yak in the quality of an okremogo lika, as well as in a warehouse complex treatment spilno with steroids.

Pulse therapy

Tsei sposіb lіkuvannya priznachayut, if there is a threat to the zoru. With a stretch of 3 dib, the patient is injected internally with prednizolone or methylprednizolone. For 4 additional patients, transfer to leaks in tablets with a decrease in dosage. Even after 3 dobi, the pulse therapy with methylprednizolone does not bring any result, it should be recognized promptly.

Pulse therapy is a number of contraindications:

• state-of-the-art infection and virus disease;
• hypertension;
• glaucoma;
• the importance of stopping the liver and nirok.

radioactive iodine

With a small increase in the thyroid gland, the emergence of universities on the new, patients will recognize radioiodine therapy. For an hour, procedure in the middle of the body to inject an active iodine molecule. Vona accumulate in the tissues of the thyroid gland, ruinuchi її. As a result, thyroid hormone production changes.

Інші methods of therapy

The patient in especially important problems is given the opportunity to optimize the external orbits for the additional help of X-rays. against ignition processes priznachayut kryopheresis, plasmapheresis, hemosorption.

To improve the metabolism and transmission of nerve impulses to the sick, prescribe Aevit, Actovegin, Prozerin.

To relieve dryness of the eyes, dry gels and specks, preparations of single layer. Tse Oftagel, Carbomer, Korneregel.

operation

It is not necessary to carry out surgery, if the parts of the "thyroid" are very bad, you will need to repair the trachea, if conservatively not bring results.

To carry out decompression of the orbit of the eyes, the staff of the eyes will recover and the loss of the eyes. After an hour of surgery, one can often see the orbital and the deterioration of the cell. The price is positive for the progress of pathology, and for the improvement of vitality.

To carry out the correction of okorukhovyh mu'yaz_v with oblique bone and swivel diplopia. To use a cosmetic defect with an operative way to carry out the growth of the capital, subconsiderly inject Botuloxin or Triamcinolone, so that it can be used again.

In some cases, they want to see a recurrent descent of the table, carry out a lateral tarsoraphy, when they sew the edges of the table.

Reduced flow of operative involvement can cause bleeding asymetry of intramuscular apples, sinusitis, diplopia, impaired sensitivity of the body.

Peculiarities of the life of the vagina

In case of endocrine ophthalmopathy, for an hour of vaginosity, mothers may be born to the nobility, who are also ill, as they are not safe for their health and the life of a baby. There is no specific way to go. Especially respect for vaginosis comes robotic thyroid gland, especially in patients with thyrotoxicosis and diffuse toxic goiter. To establish an accurate diagnosis and conduct correct lіkuvannya a differential diagnosis is required.

Treatment of diffuse goiter for an hour of vaginosity in a dose of 250 mcg of iodine, one in a second with levothyroxine sodium.

The treatment of thyrotoxicosis in cases of infestation of children is brought up to the acceptance of small doses of propylthyouracil. Yogo mark є pіdtrimka hormone T4 on the upper boundary of normal indices.

The operation is recognized only in the most common types.

Forecast and acceleration

Timely differential diagnostics, correct therapy allows the solicitous remissions and negative inheritances to be encouraged. Approximately 40% of the ailments will suffer from more pollen, and 60% will suffer from the pathological process. People should be put on the field of an endocrinologist and an ophthalmologist, while some guilty people are guilty of looking at the skin.

If you don’t carry out differential diagnostics, you can confuse ailments, as there may be similar signs. In such a situation, the wrong treatment will be indicated, but before the next acceleration:

• obliqueness;
• pogirshennya zoru;
• rounding out the rounding up.

prophylaxis

Special prophylaxis of endocrine ophthalmopathy is mute. Ale for the possibility of becoming ill when symptoms appear, it is necessary to quickly turn to an endocrinologist, an ophthalmologist. With the help of immunity, capture the eyes from the high-flown infusions, see them from the city.

Likars obov'yazkovo give all ailments onset CLINIC RECOMMENDATIONS directly from the form of ophthalmopathy:

1. Wear dark eyepieces
2. Vikoristovuvati calls for symptoms for symptoms
3. Throw a fire, as well as a unique opportunity to smoke.

Endocrine ophthalmopathy is a collapsible pathology, which is about 2% of the entire population of the planet. In most cases, it is not possible to bring it to the end, or even greatly lower it. Just a quick therapy to help you improve the development of illnesses or to increase your likelihood.

Intoxicating, by stretching out a kind of autoimmune damage, provoke snakes in tissues and myases ochnitsa, so that it manifests itself in vipinni internal apples (exophthalmias) and a complex of internal symptoms. Snacks extraocular mucous and retrobulbar cells. Three forms of endocrine ophthalmopathy were accepted - thyrotoxic exophthalmos, nodular exophthalmos, endocrine myopathy.

Reasons for the diagnosis of endocrine ophthalmopathy to be realized on the basis of thyroid dysfunction, its nature and steps to grow, protest of the middle class:

• virus infection (for example, retrovirus);
• bacterial infection (for example, Yersinia enterocolitica);
• infusion of toxins;
• radioactive injection;
• parts and strong stress;
• shkіdlivі calls (for example, kurіnnya).

Іsnu two versions to the launch of the mechanism of becoming ill. If you catch one of them, you will be able to react to antibodies to the thyroid gland, and if you get sick with diffuse toxic goiter. An alternative point of view is that the endocrine ophthalmopathy (EOP) develops independently;

• burning fabric of eyes- the stench becomes sore, worm-like, sluggish;
• species of the inner shells- fiery and thickening;
• the ruin of the ruins in person- ochni apple vstupayut from ochnitsa, intertwined with the rukhova power of muses and sprouting, doubling; іnodі rupture of full-time apples і callous every day;
• exophthalmos- vipinnya full-time apples will ruin the function of extraocular mucus and develop symptoms of Moebius, Graefe, Dahlrympl, Shtelvag too.

In parallel with the main symptomatology, the supervascular endocrine ophthalmopathy, dermal conditions of the extremities, the dominant clinical picture.

Thyrotoxic exophthalmos

• unilateral or bilateral nature of intramural pathology;
• increased gratuity;
• disturbed sleep;
• constantly seeing the heat;
• tremor of the upper symptoms;
• prvidshene sercebittya;
• zbilshennyam full-time schilins (I want eksophthalmus with a lot of dumbness, but I don’t change 2 mm);
• rіdkіsne morgannya;
• Grefe's symptom (when looking from the bottom, the sclera's face is exposed over the upper limbus); low tremor of cure in case of їkh mikanny (which is characteristic with repeated mikanny);
• obsyag rukhiv extraocular muses not damaging;
• the very bottom is to become normal, the function of the eyes does not suffer, the repositioning of the eyes is not complicated.

Pathology urge to pass the script effective therapy ailment of thyroid zalozi.

nabryakly exophthalmos

• part of the lowering of the upper line on the cob of the day, before the end of the day;
• tremor of the critical condition;
• partial ptosis quickly turn into a retraction stage of the upper vertex;
• diagnosis of non-burnt tissue periorbital tissue and internal hypertension;
• at the point of attachment of the external muzzles to the sclera, the episcleral judgment is expanded and twisted, which form the figurine of the cross;
• the internal grip zzvychay to get lost in the boundaries of the norms, or to move when looking up the hill.

Pathology of the need for treatment, splinters, accelerates the swelling, unruffiness of the intramural apple, fibrosis of tissue and atrophies of the healthy nerve.

endocrine myopathy

• develop the bilateral nature of the pathology;
• double in the eyes and the interconnection of the muck of the full-time meat, the growth of the step-by-step with the plin of the affliction;
• very yabloko zbіlshutsya deed, to develop exophthalmus with a difficult reposition;
• Significance of the cultivation of one or two new ones, the profundity of which is highly variable.

Winikak on aphids of hyperthyroidism abo euthyroid and with a high degree of immobility converts into fibrosis of tissue.

Diagnosis of endocrine ophthalmopathy Often seen on aphids of diffuse toxic goiter, EOP can also be a precursor to thyrotoxicosis. Look around allows you to see the change of soft tissues of the orbit, the appearance of the feet of the exophthalmos, which can be seen in millimeters according to the Gertl exophthalmometer. Anxiety is also diagnosed with the presence of peri-orbital fouling, internal hypertension, impaired function of gory mucous membranes, impaired corns and discoloration.

The laboratory is focused on detecting the functional activity of the thyroid gland, for which one can see the level of TTG, vilny T3 and T4 in syrovatz blood. The activity of the EOP can be established based on the results of the previous slaughter, in which there is a number of glucose aminoglycans, so the excess and efficiency of the drug can be controlled by itself.

Instrumental dosage within the framework of endocrine ophthalmopathy diagnostics is presented:

• Ultrasound in case of nabryakovy exophthalmia, it is shown that the retrobulbar zone is expanded; The sumarity of the straight lines of the eye in the sick of the EOP can reach 22.6 mm (in the healthy - 16.8 mm). The canal of the healthy nerve also grows in the middle by 22% in accordance with the norm, and in the world of development of fibrosis of soft tissues of the orbit, the width of the retrobulbar zone and speed up, the growth of extraocular mucosa is becoming more and more old. It is necessary to vrahovuvati, so ultrasonic scanning allows to visualize only 2/3 of the orbit, at that time the summit is not to look around the zone;
• CT scan in case of bulbar exophthalmia, it is possible to develop an increase in the thickness of retrobulbar fat cells as a result of an increase in the average up to -64 HU (with a norm of -120 HU). In the event of decompensation of incapacitation of extraocular mucosa, the healthy nerve is compressed in the posterior third of the orbital, its diameter is reduced by 1-2mm as a result of rapid stretching. In addition, it means the increase in periorbital tissue, the improvement of lacrimal villosities from the unclear contours, the impurity of the contours of the healthy nerve, and the draining of the superior orbital vein.

Yak lykuvati endocrine ophthalmopathy?

to imagine, the first for everything, a complex process, which is an advance of the professional diagnostics of the function of the thyroid gland, including. ineffectively lіkuvannya may have been depleted for the admission of an ophthalmologist and endocrinologist, due to the degree of severity of this pathology and often to the background, damage to the function of the thyroid gland.

Likuvannya to put in front of you a meta vidregulyuvati hormonal background in the organism and normalization of the thyroid gland function, with which to learn the following ophthalmologic studies:

• conjunctival disorders;
• increased development of keratopathy;
• reduction of internal and retrobulbar vice;
• stifling destructive processes in the tissues of the orbit;
• normalization of healthy functions.

Treatment of endocrine ophthalmopathy in the overwhelming number of vipadkivs we are nadaє unsuccessful, because I don’t vikona mainly zavdannya, but the very achievement of an euthyroid stance, with which the function of the thyroid gland is not destroyed.

drug therapy to repair the preparations, pre-riverine for singing endocrine discomfiture. Hypothyroidism is treated with levothyroxine with parallel control of the level of TSH. Hyperthyroidism is treated with thyreostatics, so that hyperthyroidism does not develop. If thyrostatics do not pull the desired result, then the vibration is seen as total thyroid dectomy, and some of Chastkov's provocation of antibodies to the TSH receptor, which will deprive it of endocrine ophthalmopathy.

At the stage of subcompensation and decompensation of ophthalmopathy, pre-river therapy with glucocorticoids. dobova dose glucocorticoids to lie down at the stage of the turn of the day symptoms and to become 40-80 mg / dose per pererakhunka on prednisolone. Such a dose of prednisolone is given 10-14 days before the effect, then step by step decrease for 3-4 ms. Small doses of predisolone are ineffective. It is widely used for intravenous administration of glucocorticoids at high doses (pulse therapy). Methylprednizolone should be administered in 1 to 8 doses, repaired at a dose of 1000 mg for 3 days, then changed 2 times. After completing the course of pulse therapy, prenizolone should be prescribed in the middle of every day with incremental dose reductions.

For the suppression of symptoms of the EOP with a high efficiency of vicious drugs, which induce T-cell activity, blockers of cytokines, monoclonal antibodies, analogs of somatostatin.

In case of steroid-resistant forms of EOP, it is necessary to carry out plasmapheresis or hemosorption. We will remain the method of lykuvannya, we will direct it to the visualization of toxic products from the blood and regulate homeostasis by the contact of blood with the sorbent, postures between the organisms.

Medication can be supplemented with X-ray therapy for the area of ​​full-time orbits, the effectiveness of which can be found during the triviality of the EOP and the dose is optimized (the change is reported as 16 or 20 Gy per course).

surgical treatment with EOP, they become vicious in especially folding drops and often because of ineffectiveness drug therapy... shown before prompt engagementє:

• endocrine myopathy - the operation is carried out with the help of polypsy of the function of extraocular mucosa, and in case of a small retraction of the upper line for renewal of its normal position;
• diplopia - the operation is carried out with the method of renewal to the normal level of full-time muscularity;
• changes from the side of the eye (retraction, lagophthalmos, ptosis, swelling and prolapse of lazy burrows), as a result of surgical intervention;
• Expansion of retrobulbar cotcini, yak to produce a rotated with proptosis with a swirling horn, a swelling of a full-time apple from an ochnitsa, a form of a rotated cosmetic defect.

In the rest of the fall, there is a decompression of the skin through the skin from the chotiroh of the stinks, and the visualization of the sinus sinus, in which a part of the Klitkovine enters, does not appear less effective.

You can be tied with yakyuvannymi

Treatment of endocrine ophthalmopathy using folk methods

Endocrine ophthalmopathy is considered to be quietly ill, which cannot be effectively treated by folk methods. The price is explained by the autoimmune nature of the affliction, the folding bindings of the officials and the comprehensive approach to the treatment, which are guiltyly carried out within the framework of traditional medicine.

Treatment of endocrine ophthalmopathy for an hour of vaginosis

Endocrine ophthalmopathy itself does not represent a sutta problem for the health of a vaginal woman, but that specific approach for treatment of endocrine ophthalmopathy the vagina are not formed. However, ophthalmopathy in the overwhelming number of vapors develops on the endocrine system, as it is necessary to take control as a whole, as well as during the period of winter conditions. Diffuse toxic goiter and thyrotoxicosis remain until the end. Їх lіkuvannya maє passes under the control of professional fakhіvtsіv.