Thyroid and the eye

Abstract

Any thyroid cancer can metastasize to the uveal tract, even after decades; medullary thyroid cancer can be part of multiple endocrine neoplasia syndrome. Superior limbic keratoconjunctivitis and lagophthalmos are prognostic markers for more severe thyroid-associated ophthalmopathy (TAO). The restrictive ophthalmopathy of TAO may be associated with more sustained ocular hypertension and require topical therapy. Several new studies address the therapy of TAO, ranging from retrobulbar to oral to intravenous glucocorticoids, alone or combined with radiotherapy. Endonasal decompression of the posterior orbit can be done well for severe optic nerve compression; however, leaving the anterior orbital septum intact can minimize postoperative diplopia. Smoking increases the risk and relapse rate for ophthalmopathy. Thyrotropin receptor antigen on fibroblasts diffusely in the body is causative in TAO and pretibial myxedema with even increased urinary secretion of glycosaminoglycans. Corticosteroid-responsive patients show a sustained up-regulation of the Th1/Th2 profile.

Painful ophthalmoplegia: Overview with a focus on tolosa-hunt syndrome

“…Although patients with Grave's disease can develop limitation of eye movement with or without proptosis, significant orbital pain is uncommon [37,38]. Infiltration of the extraocular muscles by an inflammatory process results in fibrosis and loss of elasticity, which results in restriction of the globe [37,38].…”

“…Infiltration of the extraocular muscles by an inflammatory process results in fibrosis and loss of elasticity, which results in restriction of the globe [37,38]. Findings may be unilateral or bilateral.…”

“…Lid retraction or lid lag may direct the clinician to the diagnosis. CT scanning of the orbits or MRI with fat suppression techniques typically will show at least one enlarged extraocular muscle; there usually is enlargement of the muscles with relative sparing of the tendinous insertion [37,38].…”

Treatment of Superior Limbic Keratoconjunctivitis With a Large-Diameter Contact Lens and Botulium Toxin A Treatment of superior limbic keratoconjunctivitis with a large-diameter contact lens and botulium toxin a.

“…However, hyperthyroidism [2][3][4] or dry eye syndrome 1,5 have been considered as underlying factors. In recent days, mechanical theory associated with blink-related microtrauma has been discussed.…”

“…[6][7][8][9] That is, SLK is induced by continuous rubbing of the superior palpebral conjunctiva against the superior bulbar conjunctiva under peculiar conditions such as exophthalmos, dry eye syndrome, and floppy eyelid syndrome. As a result, conjunctivochalasis, 4 keratinization, and loss of goblet cells 10 in the superior conjunctiva were frequently observed. Also biochemical factors associated with mechanical stress (TGF b2, tenascin, integrin b1) appear regularly.…”