Exophthalmos

Exophthalmos is vastanie eyeball forward (sometimes with a shift in any direction). When exophthalmos possibly limited mobility of the eyes. Exophthalmos is one of the main signs of diseases of the eye and is caused by the increase in its content. Causes of exophthalmos can be intraorbital and vneplanovyj. To intraorbital reasons include: inflammatory processes in the cavity of the eye socket, broken its walls, benign and malignant tumors, etc. To neglasnym reasons include: the common ailments of the body, thyroid gland diseases, pathological processes in a cavity of a skull, diseases of the sinuses. The degree of pistoane eyeball is determined by ekzoplanety (see Ekzoplanety). In each case the exophthalmos in order to ascertain its causes requires a comprehensive General and local studies of the patient. Exophthalmos may be accompanied by a decrease in vision damage the optic nerve. Sometimes at considerable shift in the eyes of the patients vision.
Depending on the cause proptosis, is assigned the appropriate treatment: surgery for tumors of the eye socket, treatment sinonasal diseases this area, the treatment of systemic diseases, etc.

Exophthalmos (exophthalmus, from the Greek. exophthalmos - eyed - shift eyeball patterns forward beyond the orbital plane of the hole. The correct position of the eyeball in the eye-socket is due to the normal ratio of bone orbits and its contents (fatty tissue, blood vessels, muscles, fascia, size and shape of the eyeball). True exophthalmos should be distinguished from the imaginary observed asymmetry of the sockets, the anomalies of the skull (tower skull), unilateral axial myopia, when Buffalo, when the true scleral staphyloma. When the true exophthalmos decide on his character (inflammatory or non-inflammatory) and in order to ascertain the reasons for his take into account the following: direct vastanie eyeball or shift it in any direction, the presence and degree of disturbance of mobility and the ability to reposition the eyeball when pressed on the front of him; palpation determine the volume and consistency of the content of the eye socket (seal, softening, fluctuation), the state of the edges of the socket (roughness, thickening, fistulas and other), the condition of the cornea, refraction, diplopia, Ophthalmoscope changes, painful feelings and their location, changes in related eye-socket areas, the total destruction of the organism. This requires laboratory, radiology, and so on. the research.
The etiology of exophthalmos diverse. Are distinguished: 1) ekstrakorporalny reasons: General disease (diffuse toxic goitre, leukemia and other); the defeat of the cranial cavity, nervous system, diseases of nasal cavity and paranasal sinuses; 2) intraorbital causes inflammation and fractures wall sockets; benign and malignant tumors, coming from the eye, optic nerve and the eyeball; bleeding; swelling; anophthalmic; cellulitis sockets; expansion and thrombosis; aneurysm, ophthalmoplegia.
The most interesting are the following forms of exophthalmos.
Interspersed exophthalmos (I.e. intermittens), due to the expansion of the orbital veins, observed in inclined position of the head and other conditions leading to venustas in orbit, sometimes combined with pulsating exophthalmos. The forecast is favorable. Surgery (variceal ligation) is shown in sharply rising exophthalmos, associated with severe complications and fall of view.
Pulsating exophthalmos (I.e. pulsans) occurs in most cases due to a rupture of the internal carotid artery in the cavernous sinus spontaneously (arteriosclerosis, pregnancy) or in connection with a trauma of a skull. Symptoms: ripple eyeball blowing noise in the head, listen stethoscope in the temple and eye closed eyelids; sometimes defeat III, IV, V and VI pairs of cranial and sympathetic nerves; at the bottom of the eye - varicose veins and narrowing of the arteries, hemorrhage, smitest borders of the optic nerve, often atrophy it, often ripple extended superior ophthalmic Vienna, shifting the eyeball down and outwards; ripple may spread to adjacent venous trunks up to the neck, and around the eye could be formed pulsating vascular spark. The fall of visual functions occurs due to excessive pressure or damage (injury) of the optic nerve, bleeding in the retina, thrombosis of Central veins, glaucoma, ulcers of the cornea. The mortality rate 2%, spontaneous healing in 6% of cases. Treatment: systematic obstruction of the carotid artery in the neck, ligation of the internal carotid artery, and the superior ophthalmic Vienna.
Progressive malignant exophthalmos (synonym: exophthalmic ophthalmoplegia, adeno-hypophyseal ophtalmoscopes) is associated with thyrotoxicosis, but clinical and postmortem different from exophthalmos in diffuse toxic goiter.
The pathogenesis of progressive malignant exophthalmos associated with dysfunction of the hypothalamic-pituitary-thyroid complex. The secretion of hormones the thyroid gland is regulated by thyroid-stimulating hormone from the pituitary gland; lowering the level of thyroid hormones stimulates the release of hormones from the pituitary gland; the activity of the pituitary gland depends on the activity of interstitial brain and other cerebral formations up to the brain that can affect the thyroid gland direct influence, bypassing the pituitary gland.
Malignant exophthalmos occurs more often in men aged 40-60 years; it occurs spontaneously or after total removal of the thyroid gland about gipertireoidizmom. There are moderate exophthalmos when gipertireoidizmom and progressive malignant when downgrading of the thyroid gland. The signs of the last: the process of one - or two-sided, severe pain in the eye, gradual or rapid development of exophthalmos up to the dislocation of the eyeball, reposition it is difficult and upward mobility is limited, diplopia, ulceration of the cornea due to early violation of its sensitivity and trophism, chemosis, swelling of orbital and periorbital tissue, slezotechenie; at the bottom eyes varicose veins, often stagnant nipples with the subsequent atrophy of the optic nerves, increased intraocular pressure that is put in the link dysfunction diencephalic, sometimes phenomena encephalitis. Postmortem - infiltration, dense swelling orbital fat, a sharp increase in external eye muscles fragmentation, hyalinosis and fibrosis; in the later stages - fibrosis orbital tissue.
Treatment: tireoidin, hormonal therapy, antibiotics when indicated; the most effective radiotherapy region orbit and the pituitary gland in the early stages of exophthalmos (up fibrosis).