Anatomic Considerations in Thyroid Eye Disease.
Anatomic Considerations in Thyroid Eye Disease.
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DOI：
10.1097/iop.0000000000001122
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发表时间：
2018-07-01
影响因子：
2
通讯作者：
Dutton, Jonathan J
中科院分区：
文献类型：
--
作者：
Dutton, Jonathan J
目得：目的：回顾总结甲状腺眼病（thyroid eye disease，TED）与眼睑和眼眶解剖结构相关的临床表现。方法：通过PubMed检索，寻找眼睑和眼眶解剖结构之间的解剖关系以及TED的临床表现。它们通常涉及眼睑和眼眶。在眼睑中，常见的发现包括上眼睑退缩、轮廓异常、眼睑水肿、眼眶脂肪脱垂、结膜充血和球结膜水肿、泪阜水肿和睑板腺功能障碍。这些变化的确切原因仍然是一个有争议的问题，但已经提出了许多假设，大多数都有有限的实验支持。在眼眶中，炎症和充血是急性活动期的特征，组织扩张和纤维化持续到慢性非活动期。所有这些发现至少部分是由于眼睑和眼眶的独特解剖结构及其与TED免疫过程的相互作用。在这里，我们回顾TED的这些主要特点，特别是参考他们的解剖relationships.CONCLUSIONS：TED的主要研究结果特点是与独特的解剖特征在眼睑，包括米勒肌，提上睑肌，结膜悬韧带。在眶内，Graves相关性重塑是眼外肌的特殊生理特征、眶壁结构及其与邻近鼻窦的关系以及眶脂肪对免疫挑战的反应的结果。
PURPOSE: To review and summarize the clinical findings in thyroid eye disease (TED) related to the unique anatomical structures of the eyelids and orbit.METHODS: A PubMed search was performed searching for anatomical relationships between eyelid and orbital anatomy and the clinical findings of TED.RESULTS: The major clinical findings associated with TED are varied. They typically involve both the eyelid and the orbit. In the eyelid, usual findings include upper eyelid retraction, contour abnormalities, eyelid edema, prolapsed orbital fat, conjunctival injection and chemosis, caruncular edema, and meibomian gland dysfunction. The exact causes of these changes remain a matter of controversy, but numerous hypotheses have been proposed, most with limited experimental support. In the orbit, inflammation and congestion characterize the acute active phase, with tissue expansion and fibrosis persisting into the chronic inactive phase. All of these findings result, at least in part, from the unique anatomy of the eyelids and orbit and their interaction with the immunologic processes underlying TED. Here we review these major characteristics of TED, with special reference to their anatomic relationships.CONCLUSIONS: The major findings characterizing TED are related to unique anatomic features in the eyelid, including Muller muscle, the levator palpebrae superioris muscle, and suspensory ligaments of the conjunctiva. In the orbit, Graves-related remolding results from the special physiologic features of the extraocular muscles, the structure of the orbital walls and their relations to adjacent paranasal sinuses, and the reaction of orbital fat to immunologic challenges.