EXOPHTHALMOS (Greek ekh-from + ophthalmos of eyes; synonym: pucheglazy, a protrusion of an eye, a pro-ptosis) — a pathological vystoyaniye of an eyeglobe from an eye-socket.
Distinguish true and false E. Istinny E. is a symptom patol. the processes which are localized in a cavity of an eye-socket, and nek-ry general diseases. False E. it is observed at persons with inborn asymmetry of bones of a facial skeleton. Sometimes E. arises at the unilateral sharply expressed short-sightedness, paralysis of outside muscles of an eye. There is also a natural asymmetry of a vystoyaniye of eyes, however at most of people the difference does not exceed 0,5 mm and therefore it is almost imperceptible; extremely seldom it reaches 1,5 — 2 mm.
Degree of a vystoyaniye of eyeglobes from an eye-socket is determined by the special device — an ekzoftal-mometr (see Ekzoftaljmometriya).
True E. on a wedge, to signs divide on stationary (constant), pulsing and intermittent (alternating).
The stationary exophthalmos develops at the tumors arising initially in tissues of an eye-socket or burgeoning in it from the neighboring areas, napr from adnexal bosoms of a nose; at inflammatory diseases or an injury of an eye-socket with formation of a hematoma; nek-ry inborn and parasitic cysts of an eye-socket; malformations (nek-ry types of dysostoses and brain hernias); a psevdotumor (pseudoneoplasm) — hron. nonspecific inflammation of tissues of eye-socket; at endocrine diseases — endocrine E., including E. at a thyrotoxicosis (see the Craw diffusion toxic) and edematous progressing E. — a so-called disease of Greyvs (see the Eye-socket).
AA. at malignant tumors of an eye-socket quickly progresses.
Restriction of movements of an eyeglobe and its shift aside, opposite to localization of a tumor is characteristic; at the central arrangement of a tumor in an eye-socket it is observed axial E. In process of growth of a tumor of the movement of an eyeglobe are sharply limited, there is a chemosis, and in later terms — feeling of tension in an eye-socket, is frequent in combination with arching pains.
AA., connected with inflammatory diseases, an injury, inborn diseases and parasitic cysts of an eye-socket, happens unilateral. It resembles E superficially. at a malignant tumor, however the wedge, pictures of a basic disease and results rentgenol is distinguished usually without difficulties on the basis of data of the anamnesis. researches.
AA. at a psevdotumor of tissues of eye-socket quickly progresses; the immovability of an eyeglobe and shift it towards the affected muscle or a total ophthalmoplegia is early noted (see). AA. at a psevdotumor of an eye-socket it is similar with E. at a malignant tumor of an eye-socket; finally the issue of character of a basic disease is resolved only at an operative measure — a trial orbitotomy (see) with an urgent biopsy.
AA. the wedge, displays of a thyrotoxicosis is one of the most characteristic (see). It develops more often gradually, as a rule, happens bilateral. Degree E. at the same time does not exceed 4 — 5 mm, mobility of eyeglobes is not limited, the cornea and a conjunctiva are not changed. Pain is absent.
Etiology and pathogeny edematous E. finally are not found out. According to most of researchers, pathogenetic it is connected with excess products of thyritropic hormone. One of proximate causes of emergence edematous E. consider dystrophic changes in outside muscles of an eye that leads to disturbance of venous outflow and increase in vnutriglaznich-ny pressure, restriction of movements of eyeglobes. For edematous E. pains in eyeglobes and in a forehead, feeling of a foreign body in eyes, burning, a photophobia, dacryagogue, a diplopia are characteristic. Restriction of mobility of eyeglobes up, knaruzh is observed. The century swelled makes an impression of the raised eyebrows. AA. can reach big degree (to 20 — 35 mm and more), is followed by a considerable chemosis.
The pulsing exophthalmos most often is a sign of defeat of a carotid and cavernous anastomosis, aneurism of an orbital artery and other vascular changes, the arisen hl. obr. as a result of a craniocereberal injury, and also accompanies arterial hemangiomas of an eye-socket. In rare instances pulsing E. appears at well vaskulyarizirovan-ache to a tumor of an eye-socket or brain hernia.
At pulsing E. the visible pulsation of an eye is noted, the blowing noise listened in a verkhnevnutrenny corner of an eye at the closed centuries or over a mastoid is possible.
The intermittent (alternating) exophthalmos arises hl. obr. at a varicosity of an eye-socket. It appears only during an exercise stress or at the certain position of the head leading to disturbance of normal outflow of blood from an eye-socket. The diagnosis is specified by means of an orbital venografiya (see the Eye-socket, methods of a research).
Emergence E. and the nature of its development serve important a wedge, a sign of a row patol. states, however diagnostic and differentsialnodiagnostichesky value E., especially at hemilesion, it is limited. Only comprehensive examination of the patient with use of tool methods of a research in combination with the careful analysis available a wedge, symptoms allows to establish in most cases the diagnosis of a basic disease and to carry out the directed treatment.
Bibliography: B r about in to and N and A. F. New growths of an orbit, page 157, M., 1974; B of a rovna of N and A. F., Yurovsky H. N and Naumovat. P. Classification and clinical features of an endocrine ophthalmopathy, Vestn. oftalm., No. 1, page 40, 1983; The Multivolume guide to eye diseases, under the editorship of V. N. Arkhangelsky, t. 3, book 2, page 525, 533, M., 1962;
S e r g about t t R. Page of a. G 1 a s e of of J. S. Graves' ophthalmopathy, Surv. Ophthal., v. 26, p. 1, 1981; TrokelS. L. a. Jakob i-e with F. A. Correlation of CT scanning and pathologic features of ophthalmic Graves’ disease, Ophthalmology, v. 88, p. 553, 1981.
A. F. Brovkina.