Baldeschi Lelio
Orbital Center, Department of Ophthalmology, University of Amsterdam, Amsterdam, The Netherlands.
Dev Ophthalmol. 2008;41:103-126. doi: 10.1159/000131084.
Exophthalmos and eyelid retraction are typical symptoms of many orbital or systemic diseases, Graves' orbitopathy being the commonest. Independently from the cause, both may increase evaporation with drying of the ocular surfaces resulting in pain, tearing, and photophobia. The structural integrity of the cornea may also be damaged with possible compromise of the visual function. Acute onset of exophthalmos and/or eyelid retraction deserves maximum attention. In order to avoid corneal decompensation and waiting for a more definitive treatment, eye lubricants, moisture chambers, swimming goggles, temporary tarsorrhaphies or blepharorrhaphies represent the measures of choice. Exophthalmos depending on neoplastic, vascular, infectious, inflammatory or malformative causes is, in the majority of cases, amenable of medical or surgical causative treatment while, for endocrine exophthalmos the commonest treatment is surgical and symptomatic and consists of orbital bone decompressions. Eyelid retraction due to active inflammatory processes can be treated medically while for persistent eyelid retraction the treatment is surgical and based on lengthening of the anterior, and/or posterior, and/or mid-eyelid lamellae. Exophthalmos and eyelid retraction due to Graves' orbitopathy, their influence on ocular surface disorders and the treatment of these conditions will be specifically analysed in this chapter.
眼球突出和眼睑退缩是许多眼眶或全身性疾病的典型症状，其中格雷夫斯眼眶病最为常见。无论病因如何，两者都会增加眼表蒸发，导致眼表干燥，进而引起疼痛、流泪和畏光。角膜的结构完整性也可能受损，视觉功能可能受到影响。眼球突出和/或眼睑退缩的急性发作值得高度关注。为避免角膜失代偿并等待更确切的治疗，眼部润滑剂、保湿眼罩、泳镜、临时睑裂缝合术或眼睑缝合术是首选措施。多数情况下，由肿瘤、血管、感染、炎症或畸形等原因引起的眼球突出可通过药物或手术进行病因治疗，而内分泌性眼球突出最常见的治疗方法是手术及对症治疗，包括眼眶骨减压术。因活动性炎症过程导致的眼睑退缩可采用药物治疗，而对于持续性眼睑退缩，则采用手术治疗，即延长眼睑前层、和/或后层、和/或中层板层。本章将具体分析格雷夫斯眼眶病所致的眼球突出和眼睑退缩、它们对眼表疾病的影响以及这些病症的治疗方法。
