Endocrine orbit disorders. Pathogenesis, clinical presentation and examination, stage-dependent therapy
Eckstein, A.; Esser, J.
Der Ophthalmologe Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 100(10): 857-880
2003
ISSN/ISBN: 0941-293X PMID: 14986660 Document Number: 564898
Thyroid-associated ophthalmopathy (TAO) is an inflammatory orbital disease, which is associated with Graves' hyperthyroidism. The course of Tao is influenced by thyroid disease so that a severe course of the disease is associated with high hormone levels at the beginning of the disease, high thyroid volume and high Tsh receptor antibody (TSHR-AB) levels. Expression of Tshr is augmented in orbital tissue from patients with TAO. TSHR-ABs are associated with the course of the disease. Other important influencing factors include enviromental factors such as smoking and stress and a genetic susceptibility. A great advantage for the initiation of therapy is the introduction of the concept of disease activity and severity. Oral and intravenous steroids and/or orbital irradiation are still the widely accepted therapeutic options, which have been proven in controlled studies. The efficacy of new antiinflammatory and immunosuppressive drugs (somatostatin analogs, antioxidans) have to be proven in prospective controlled trials. In the inactive state new and classical surgical techniques are available for rehabilitation. Important is to start with orbital surgery, followed by extraocular muscle surgery and finally followed by lid correction.