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Phenotypes of endocrine ophthalmopathy: clinical manifestation and tomographic characteristics

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Abstract


The clinical manifetstations of endocrine orbitopathy (EOP) significantly because autoimmune process may involve various anatomical structures of the eye. Choosing an effective method for EOP treatment requires to determine the selectivity of orbital tissue damage, which is difficult when only clinical criteria are applied. 102 patients with EOP and Graves’ disease were examined. All patients underwent the standard ophthalmological examination and multispiral computed tomography of orbits. The analysis of clinical and tomographic parameters allowed us to distinguish 3 variants of EOP flow: classical, lipogenic, and myogenic. The prevailing symptoms of patients with the lipogenic variant were distinct exophthalmos without a disturbance of the function of extraocular muscles (EOM) and visual disturbances. Oculomotor disorders, diplopia, strabismus, and decreased vision were prevalent in patients with the myogenic variant. Patients with the classical variant suffered from exophthalmos, periorbital edema, and oculomotor disorders. The identification of independent clinical variants of EOP with specific clinical symptoms and different tomographic characteristics testifies different pathogenetic mechanisms of EOP development is to determine personalized approaches to treatment.


Irina M. Belovalova

Endocrinology Research Centre

Author for correspondence.
Email: belovalova.irina@endocrincentr.ru
ORCID iD: 0000-0002-9954-7641
SPIN-code: 7158-0658

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Natalya Yu. Sviridenko

Endocrinology Research Centre

Email: natsvir@inbox.ru
ORCID iD: 0000-0002-8538-5354
SPIN-code: 5889-6484

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD, Professor

Elena G. Bessmertnaya

Endocrinology Research Centre

Email: bessmertnaya.eg@gmail.com
ORCID iD: 0000-0001-5910-6502
SPIN-code: 1273-3426

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Anna A. Chepurina

Endocrinology Research Centre

Email: chepurina_a@mail.ru
ORCID iD: 0000-0002-2713-3036
SPIN-code: 9242-6808

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Marina S. Sheremeta

Endocrinology Research Centre

Email: marina888@yandex.ru
ORCID iD: 0000-0003-3785-0335
SPIN-code: 7845-2194

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Alexander A. Mikheenkov

Endocrinology Research Centre

Email: Mikheenkov_Alexander@mail.ru
ORCID iD: 0000-0001-9981-1767
SPIN-code: 6824-5971

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

endocrinologist 

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Supplementary files

Supplementary Files Action
1. Fig. 1. Chronological relationship between the manifestation of thyrotoxicosis in Graves' disease and the appearance of symptoms of endocrine ophthalmopathy. View (81KB) Indexing metadata
2. Fig. 2. Eye symptoms associated with thyrotoxicosis: retraction of the upper eyelids (a, b). View (695KB) Indexing metadata
3. Fig. 3. The frequency of detection of 11 eye symptoms in patients with Graves' disease after surgical treatment. View (167KB) Indexing metadata
4. Fig. 4. Lipogenic variant of endocrine ophthalmopathy. a - a photograph of a patient with severe exophthalmos View (666KB) Indexing metadata
5. Fig. 4. Lipogenic variant of endocrine ophthalmopathy. b - MSCT of the orbits, axial projection (the eyeballs are located above the interscale line - the white line). View (596KB) Indexing metadata
6. Fig. 5. Clinical manifestations of EOP with selective involvement of EOM. Pronounced asymmetry of the position of the eyeballs in orbits. and - paralytic squint, mainly vertical type View (687KB) Indexing metadata
7. Fig. 5. Clinical manifestations of EOP with selective involvement of EOM. Pronounced asymmetry of the position of the eyeballs in orbits. b - MSCT, coronal projection OS - an increase in the lower straight and outer rectus muscles. View (624KB) Indexing metadata
8. Fig. 6. Clinical manifestations of EOP with involvement of EOM and RBC. a - photo View (652KB) Indexing metadata
9. Fig. 6. Clinical manifestations of EOP with involvement of EOM and RBC. b - MSCT, axial projection: compression of the optic nerve (white arrows) in a patient with a severe form of image intensifier, complicated by optical neuropathy. View (601KB) Indexing metadata
10. Рис. 7. МСКТ, корональная проекция: визуализируются увеличенные слезные железы (белые стрелки) View (54KB) Indexing metadata
11. Fig. 8. Clinical manifestations of endocrine ophthalmopathy with optic neuropathy. a - photo of a patient with EOP and optic neuropathy View (650KB) Indexing metadata
12. Fig. 8. Clinical manifestations of endocrine ophthalmopathy with optic neuropathy. b - MSCT of the orbits, coronal projection - compression of the optic nerve (white arrows) at the apex of the orbit increased in volume of the EOM. View (596KB) Indexing metadata
13. Fig. 9. Pronounced bilateral lagophthalmos. a - non-closure of the eyelids during sleep View (607KB) Indexing metadata
14. Fig. 9. Pronounced bilateral lagophthalmos. b - compression of the optic nerve (white arrows) in a patient with a severe form of image intensifier, complicated by optic neuropathy and severe exophthalmos. View (595KB) Indexing metadata

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Copyright (c) 2019 Belovalova I.M., Sviridenko N.Y., Bessmertnaya E.G., Chepurina A.A., Sheremeta M.S., Mikheenkov A.A.

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