Mallika Ps, Tan Ak, Aziz S, Alwi Sar Syed, Chong Ms, Vanitha R, Intan G
Malays Fam Physician. 2009 Apr 30;4(1):8-14. eCollection 2009.
Thyroid associated ophthalmopathy is an autoimmune disorder affecting the orbital and periorbital tissues. Hyperthyroidism is commonly associated with thyroid associated ophthalmopathy, however in 5% to 10% of cases it is euthyroid. Genetic, environmental and endogenous factors play a role in the initiation of the thyroid ophthalmopathy. Smoking has been identified as the strongest risk factor for the development of the disorder. The pathogenesis involves activation of both humoral and cell mediated immunity with subsequent production of gycoaminoglycans, hyaluronic acid resulting in oedema formation, increase extraocular mass and adipogenesis in the orbit. The natural history of the disease progresses from active to inactive fibrotic stage over a period of years. Diagnosis is mainly clinical and almost all patients with ophthalmopathy exhibit some form of thyroid abnormality on further testing. Treatment is based on the clinical severity of the disease. Non-severe cases are managed by supportive measures to reduce the symptomatology and severe cases are treated by either medical or surgical decompression. Rehabilitative surgery is done for quiescent disease to reduce diplopia and improve cosmesis.
甲状腺相关性眼病是一种影响眼眶和眶周组织的自身免疫性疾病。甲状腺功能亢进症通常与甲状腺相关性眼病有关，但在5%至10%的病例中，患者甲状腺功能正常。遗传、环境和内源性因素在甲状腺眼病的发病过程中起作用。吸烟已被确定为该疾病发展的最强危险因素。其发病机制涉及体液免疫和细胞介导免疫的激活，随后产生糖胺聚糖、透明质酸，导致水肿形成、眼外肌质量增加和眼眶脂肪生成。该病的自然病程在数年中从活动期发展到非活动纤维化期。诊断主要依靠临床症状，几乎所有眼病患者在进一步检查时都会出现某种形式的甲状腺异常。治疗基于疾病的临床严重程度。非严重病例通过支持性措施来减轻症状，严重病例则通过药物或手术减压治疗。对于静止期疾病，进行康复手术以减少复视并改善外观。
