Ekzoftalm is a mono or binocular shift of an eyeball forward. The general symptoms for the majority of forms are the complicated movements by eyes, a diplopiya, feeling of burning and gripes in connection with the increased dryness of a conjunctiva. Diagnostics of an ekzoftalm is based on collecting the anamnesis, carrying out external examination, an ekzoftalmometriya, oftalmoskopiya, vizometriya, tonometriya, biomicroscopy, BRIDLES, OCT. Tactics of treatment depends on a disease etiology. At traumatic genesis the kantotomiya, drainage of retrobulbarny space is recommended. Endocrine is the indication to reception of tireostatik and hormones, at low efficiency the tireoidektomiya is carried out.
Ekzoftalm represents the pathological protrusion of an eyeball from an orbit cavity which is not followed by increase in its longitudinal size. For the first time pathology was described as a symptom of an endocrine ophthalmopathy in 1776 by the Irish surgeon R. J. Greyvs. In 1960 the Soviet neurosurgeons I. M. Irger and L. A. Koreysh submitted data that the shift of eyeballs of a kpereda can arise at pathological new growths of a cerebellum. Ekzoftalm of the endocrine nature by 6-8 times meets among female persons more often, post-traumatic genesis of a disease is more characteristic of men. Clinical manifestations of an ekzoftalm are widespread in all age groups.
Reasons of an ekzoftalm
The most widespread etiologichesky factor of an ekzoftalm is the endocrine ophthalmopathy. Dysfunction of immune system at which there is hypostasis of hypodermic and fatty cellulose of an orbit and external muscles of an eyeball (an edematous form) is the cornerstone of the mechanism of development of this pathology. At this stage of manifestation of an ekzoftalm can be exposed to the return development. Progressing of a disease leads to formation of cicatricial defects in glazodvigatelny muscles that provokes irreversible changes. Autoimmune defeat of retrobulbarny cellulose at Greyvs's disease is caused by the mechanism of cross response of antibodies of an organism to anti-genes of a thyroid gland and tissue of an eye-socket. Confirmation of the tireotoksichesky theory of pathogenesis is the raised caption of antibodies to receptors of tireotropny hormone.
Less often development of an ekzoftalm is caused by the isolated autoimmune defeat of retrobulbarny fabric. At the same time pathological antibodies are synthesized to muscles of the glazodvigatelny device, fibroblasta and cellulose of an eye-socket. A specific marker of a disease are antibodies to periorbitalny cellulose since immunoglobulins to miotsita are defined only at a part of patients. Influence of such factors as a stress, viruses, toxic substances and radiation at genetically compromised persons stimulates production of anti-genes.
As the trigger of an ekzoftalm inflammatory processes with intra orbital localization act. At an inflammation of fatty cellulose or a vaskulita of vessels of an eye-socket there is a mechanical reason of a vypiraniye of an eyeball. Becomes more rare an etiologichesky factor of an ekzoftalm dakrioadenit, good-quality or malignant new growths. The varicosity, an angiopatiya or traumatic damages can lead to the shift of bone fragments or hemorrhage in an orbit cavity that provokes development of a clinical picture of pathology.
Symptoms of an ekzoftalm
According to clinical classification, distinguish constant, pulsing and alternating . On dynamics of development allocate not progressing, slowly and quickly progressing, regressing shift of an eyeball of a kpereda. Slow increase of a clinical picture is demonstrated by increase in the size of an eyeball by 1-2 mm for 1 month. At bystry progressing the size of an eye increases by more than 2 mm less than in 30 days. Pathology proceeds binokulyarno, however at initial stages perhaps monocular defeat more often. Ekzoftalm can be a symptom of a set of diseases. The clinical picture is defined by degree of shift of an eyeball of a kpereda. Diameter of an eyeball of 21-23 mm corresponds to the I degree, 24-26 – ІІ degrees, 27 and more – the III degrees of an ekzoftalm.
At І degrees the disease can proceed asymptomatically. It is possible to reveal pathological changes of an organ of vision only at special inspection. At an ekzoftalma ІІ patients show to degree complaints to the complicated movements by eyeballs, doubling before eyes. At unilateral defeat the clinical picture of a strabizm develops. A specific symptom of the alternating disease form – increase of manifestations of an ekzoftalm at a breath delay, a ducking, a compression of a jugular vein.
ІІІ extent of pathological process considerably complicates process of a smykaniye a century. Thereof production of a secret is broken by meybomiyevy glands that in total with impossibility of blinking and closing of eyes results in the increased dryness of an orbital conjunctiva. At the same time patients show complaints to feeling of burning and gripes in eyes. Progressing of an ekzoftalm is complicated by a secondary keratopatiya with the subsequent formation of sites of an ulceration. Clinical manifestations are hyperaemia, morbidity, photophobia. Also perhaps raised dacryagogue that strengthens a cornea travmatization. At ІІІ extents of defeat there is a compression of a disk of an optic nerve therefore common symptoms of the expressed ekzoftalm are the progressing decrease in visual acuity up to a total blindness, a pain syndrome with irradiation in frontal lobes and nadbrovny arches.
Diagnostics of an ekzoftalm
Diagnostics of an ekzoftalm is based on anamnestichesky yielded, results of external examination, an ekzoftalmometriya, oftalmoskopiya, vizometriya, tonometriya, biomicroscopy, ultrasonic diagnostics (BRIDLES) in the V-mode, the optical coherent tomography (OCT). Anamnestichesky data often indicate a disease etiology (traumatic damages, allergic reactions, pathological new growths). At external examination the vypiraniye of eyeballs from an eye-socket is defined, monocular defeat is followed by a strabizm. Ekzoftalmometriya is carried out by means of Gertel's ekzoftalmometr. This way allows to establish degree of expressiveness of an ekzoftalm.
At the III degree of pathology the oftalmoskopichesky picture corresponds to a compression of the disk of an optic nerve (DON). At the same time pale or edematous DZN is visualized, small sites of hemorrhage are less often observed. By method of biomicroscopy it is possible to reveal superficial keratopatiya, cornea ulceration zones. When carrying out a tonometriya the level of increase in intraocular pressure which, as a rule, deviates reference values at ІІ-ІІІ disease degrees is defined. At development of secondary complications of an ekzoftalm (DZN compression) there is a progressive decrease in visual acuity.
For OCT puffiness of periorbitalny cellulose, pathological new growths in an eye-socket, sites of hemorrhage are visualized. Eye BRIDLES in the V-mode allows to define degree of an ekzoftalm, to estimate a condition of surrounding fabrics. The method of ultrasonography is recommended in ophthalmology for observation of a progression or regression of a disease in dynamics. If is one of symptoms of pathology of a thyroid gland, it is recommended to determine the level of a tiroksin, triyodtironin, tireotropny hormone, and also to conduct ultrasonic examination of gland.
Treatment of an ekzoftalm
Tactics of treatment of an ekzoftalm is defined by an etiology and degree of expressiveness of a disease. At a traumatic origin in case of lack of movements of an eyeball carrying out a kantotomiya in a zone of external soldering for achievement of a decompression is recommended a century. As regional anesthesia 0,5 ml of 2% of solution of novocaine are used. Before a section of a sheaf it is fixed a special styptic clip. The line of a section is prolonged up to bone edge of an orbit. If mobility of an eyeball is kept, but owing to massive hemorrhage intraocular pressure quickly increases, it is required to execute drainage of retrobulbarny space.
At development of an ekzoftalm in patients with an endocrine ophthalmopathy the purpose of therapy is achievement of an eutireoidny state. Correction of hormonal balance by means of tireostatik and hormones is for this purpose carried out. During treatment it is necessary to humidify in due time a conjunctiva by means of medicines of an artificial tear, to carry out daily control and if necessary correction of intraocular pressure. In case of the autoimmune nature of an ekzoftalm the complex of medical actions includes reception of glucocorticoids. If medicamentous therapy does not render due effect, removal of a thyroid gland with the subsequent replacement hormonal therapy is recommended.
Forecast and prevention of an ekzoftalm
Specific measures for prevention of an ekzoftalm in ophthalmology it is not developed. Nonspecific preventive measures come down to correction of a hormonal imbalance, observance of safety measures on production. All patients with suspicion on need to undergo inspection at the ophthalmologist. Violation of visual functions at this pathology is defined by degree of a compression of a disk of an optic nerve. The forecast at an ekzoftalma depends on an etiology. At the endocrine nature the course of a disease after correction of a hormonal background favorable. Eyeball shift at malignant intra orbital new growths, tumors of a cerebellum is associated with the adverse forecast.