Endocrine secretion regulates the oxidation and metabolism of various organs and tissues in the human body, thereby maintaining normal and healthy bodily functions. Excessive or insufficient secretion can lead to diseases. Clinically, it is commonly classified into two categories: thyrotoxic exophthalmos and thyrotrophic exophthalmos.

bubble_chart Etiology

1. Thyrotoxic Exophthalmos

The occurrence of thyrotoxic exophthalmos may be attributed, on one hand, to the excited state of the sympathetic nerves, which causes tension and contraction of the orbital smooth muscles, pulling the eyeball forward. On the other hand, the thickening and relaxation of the lateral rectus muscle reduce the backward pulling force on the eyeball, allowing the tendency for forward displacement to take effect. Additionally, the subsequent filling of the orbital fat into the space left behind the eyeball prevents the eyeball from returning to its original position even under external pressure.

2. Thyrotropin-Induced Exophthalmos

Excessive secretion of thyrotropin due to hyperfunction of the anterior pituitary or total thyroidectomy leads to what is known as pituitary exophthalmos (malignant exophthalmos). Recent research suggests a possible association with immune factors. Under normal circumstances, the feedback interaction between thyroid hormone and thyrotropin maintains a balanced state. Therefore, performing a thyroidectomy while exophthalmos is in a progressive state carries the risk of exacerbating the condition.

bubble_chart Diagnosis

1. Thyrotoxic Exophthalmos

Thyrotoxic exophthalmos is also known as exophthalmic goiter.

Graves' disease is a condition characterized by exophthalmos and thyroid enlargement, which can be divided into two types based on thyroid function status:

1. Ocular Graves' disease: Exophthalmos accompanied by diffuse thyroid enlargement but with normal thyroid function.
2. Graves' eye disease: Diffuse thyroid enlargement, exophthalmos, and either hyperthyroidism or hypothyroidism, each further divided into two subtypes.

For influenza, enterovirus, and various viral colds, TCM is more refined, non-toxic, and effective than modern medicine

Graves' disease is clinically common, particularly among middle-aged women, and is an autoimmune disorder. It represents a hyperactive phenomenon of tissue metabolism and nervous system reactivity, possibly triggered by psychological trauma as a stress response.

2. Thyrotropin-Induced Exophthalmos

This condition is often bilateral and more prevalent in middle-aged men. Ocular symptoms are more prominent than systemic toxic symptoms, and due to the pronounced exophthalmos, it is also termed exophthalmic ophthalmoplegia. The protrusion of the eyeball is straight forward. In the early stages, the upper eyelid often retracts upward, with severe edema of the eyelid and conjunctiva. The contents of the eyelid feel firm to the touch, which can lead to incomplete eyelid closure and exposure keratitis, or even suppurative corneal ulcers or perforation. Additionally, it is frequently accompanied by extraocular muscle paralysis, restricted eye movement, and diplopia. Fundus examination may reveal retinal hemorrhage and optic disc edema, caused by increased orbital pressure leading to retinal venous obstruction. Elevated intraocular pressure can also compress the optic nerve, resulting in compromised central vascular supply, reduced vision, and glaucoma-like visual field defects, potentially leading to optic atrophy.

bubble_chart Treatment Measures

1. Thyroid Toxic Exophthalmos

is primarily treated with internal medicine, generally using antithyroid drug therapy. Radioactive isotope iodine-131 and subtotal thyroidectomy have equivalent therapeutic effects. For exophthalmos, symptomatic treatment should be adopted, such as protecting the highly exposed cornea to prevent dryness and infection by applying anti-inflammatory ointments and wearing eye masks; partial tarsorrhaphy can reduce corneal exposure, while hormone therapy remains inconclusive.

Local care should focus on protecting the cornea to prevent infection. For severe conjunctival edema, corticosteroid eye drops or subconjunctival/retrobulbar injections of dexamethasone can be used. Some advocate the use of 5–10% guanethidine eye drops to treat eyelid retraction or a single retrobulbar injection of hyaluronidase (500 units). Systemic treatment may involve high-dose corticosteroids and thyroid extracts, primarily to suppress thyrotropin secretion, with X-ray irradiation of the pituitary-hypothalamic region as an option. Surgical therapy is rarely used nowadays, but orbital decompression may be performed when necessary.