Endokrine Orbitopathie

Zusammenfassung

Die endokrine Orbitopathie (EO) ist Teil einer systemischen Autoimmunerkrankung (Prävalenz von 0,5 – 2 %), die eine Hyperthyreose, eine Orbitopathie, eine Akropachie und das prätibiale Myxödem umfasst (Morbus Basedow). Anti-TSH-Rezeptor-Antikörper spielen eine zentrale pathogenetische Rolle und hohe Spiegel sind mit einem schweren Krankheitsverlauf assoziiert. Kardinalsymptome der EO sind periorbitale Entzündung, Exophthalmos, verringerte Augenbeweglichkeit und erweiterte Lidspalten. Bei der Entstehung der Orbitopathie spielen die entzündlichen Reaktionen der Orbitafibroblasten die zentrale Rolle. Bei moderaten und schweren Verläufen ist eine antientzündliche Therapie (meist i. v. Steroidstoß und Orbitabestrahlung) und im Notfall eine Orbitadekompression indiziert. Bei milden Verläufen kann abgewartet oder Selen verabreicht werden. Operative Maßnahmen (Dekompression, Augenmuskelchirurgie, Lidchirurgie) haben im inaktiven Stadium die Wiederherstellung eines normalen Aussehens und der Funktion zum Ziel. Bei Rauchern tritt eine EO häufiger auf, verläuft schwerer und spricht schlechter auf die Therapie an. Die Normalisierung der Schilddrüsenfunktion führt bei mehr als der Hälfte der Patienten zu einer Verbesserung der EO.

Abstract

Graves’ orbitopathy (GO) is part of an autoimmune systemic disease (prevalence of 0.5 – 2 %) which is composed of hyperthyroidism, orbitopathy, dermopathy and acropachy. Stimulating antibodies against the TSH receptor plays the central pathogenetic role and high levels indicate the risk of a severe course of the disease. The main symproms of GO comprise soft tissue inflammation, proptosis impairment of ocular motility and lid retraction. Inflammatory reactions of orbital fibroblasts are responsible for the symptoms. To restrict damage, anti-inflammatory therapy (mainly i. v. systemic steroids, orbital irradiation) is indicated in moderate to severe active disease stages, and surgical orbital decompression is indicated in sight-threatening states. In mild GO selenium administration and otherwise a wait and see strategy is sufficient. In inactive disease stages surgery (orbital decompression, eye muscle surgery and lid surgery) is performed to improve appearance and function. Smoking increases the prevalence and severity of GO and reduces the efficiency of therapy. Restoring euthyroidism leads to an improvement of GO in about 60 % of the patients.

Schlüsselwörter

Orbita - Plastische Chirurgie - Lider - endokrine Orbitopathie

Key words

orbit - Plastic Surgery - lids - Graves’ orbitopathy

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