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The article presents the main differential diagnostic signs of pseudotumor orbit and decompensated edematous exophthalmos on the basis of its own clinical observation.

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The accumulated clinical experience proves the existence of glucocorticoid-resistant forms of endocrine ophthalmopathy. It is assumed that epigenetic factors (miRNA) affect the pathogenesis of the disease and are involved in the formation of the glucocorticoid response. Purpose. To study the role of miRNA-146a and miRNA-155 in patients with clinical forms of endocrine ophthalmopathy and to assess their effect on the glucocorticoid response. Material and method: The study included 20 patients (40 orbits) with image intensifier tubes, treated with glucocorticoids (GC) with a negative result, mean age – 52.65 ± 12.6 years. The control group - 28 volunteers without autoimmune and tumor diseases, age 62.9 ± 7.54 years. The expression level of miRNA-155 and miRNA-146a was determined by real-time PCR. Results: The obtained data indicate an increase in the expression level of miRNA-146a and miRNA-155 in patients with clinical forms of endocrine ophthalmopathy at the stage of fibrosis (p <0.01). Conclusion: The obtained results of the functional activity of miRNA-146a and miRNA-155 confirm their participation in the pathogenesis of the development of edematous exophthalmos and endocrine myopathy by activating the fibroplastic process. Key words: endocrine ophthalmopathy, GC therapy, microRNA.

The pathological process of endocrine ophthalmopathy is based on damage to the soft tissues of the orbit against the background of impaired thyroid function and even its euthyroid state. The pathogenetic mechanisms of the development of clinical symptoms of endocrine ophthalmopathy (EOP) are based on morphological changes in extraocular muscles (EOM) and orbital tissue: cellular tissue infiltration by representatives of the immune system (T- and B-lymphocytes, macrophages, mast and plasma cells), with the production of pro-inflammatory cytokines, fibroblasts and glycosaminoglycans, contributing to an increase in the contents of the orbit in volume with the development of exophthalmos and tissue fibrosis at the end of the inflammatory process. Glucocorticoids are the gold standard for the pathogenetic treatment of patients with clinical forms of endocrine ophthalmopathy: edematous exophthalmos and endocrine myopathy. The properties of drugs of this group are such that they can be used to suppress all stages of inflammation in the orbital tissues, preventing the progression of the disease. Despite the many years of experience in applying various glucocorticoid therapy techniques, to date there are no uniform criteria for the effectiveness of this treatment in patients with endocrine ophthalmopathy. The article presents the features of glucocorticoid therapy of endocrine ophthalmopathy, as well as literature data, on the basis of which attempts have been made to explain the causes of glucocorticoid resistance taking into account the pharmacogenetic profile.