Nykolyuk A. Early diagnostic criteria and treatment of thyroid ophthalmopathy

Dissertation is devoted to the actual scientific question of early differential diagnostics of thyroid ophthalmopathy clinical forms, early detection of compressive optic neuropathy and increase of efficiency of conservative treatment of the congestive exophthalmos. 141 patient with thyroid ophthalmopathy were examined. It was revieled that the development of heavier clinical forms is related to the protracted hyperthyroidism, hypothyroidism, high titres of anti-thyroid antibodies and smoking. The early complex of symptoms, characteristic for different clinical forms was detected. The clear differential-diagnostic criteria of clinical forms were set using data of oculometric indexes (degree of retraction of the upper eyelid, exophthalmos, volume of eye movements) and by the results of orbital computed tomography (length of retrobulbar space, thickness of extraocular muscles), which showed a high cross-correlation connection with each other. The method of early diagnostics of compressive optic neuropathy on the basis of determination of retinal contrast sensitivity and microophthalmoscopia was worked out. It was proposed a method of predicting of congestive exophthalmos, which is based on the examination of orbital hemodynamics indexes and a volume of eye movements. The treatment of 25 patients with the initial stage and 28 patients with the expressed stage of congestive exophthalmos was conducted. A greater efficiency of conservative treatment with administration of retrobulbar injections of kenalog in relation to the regress of basic external symptoms of congestive exophthalmos and increase of visual functions was well-proven in a group with the initial stage of congestive exophthalmos, that was revieled due to the worked out differential criteria.