Algorithm of Clinical-Tomographic Staging of Exophthalm in Patients With Thyroid Dysfunction

Abstract

Background. Computed tomography (CT) allows visualizing the bone and soft tissue structures of the orbit in a three-dimensional projection, fixing the position of the eyeball and determining the causes of the development of exophthalmos. The aim of the study was to develop an algorithm for CT diagnostics of exophthalmos in patients with endocrine ophthalmopathy. Material and methods. CT with determination of bone and soft tissue structures of the orbits in three-dimensional projection was performed in 90 patients with image intensifier, whose exophthalmometry data exceeded 18mm. Considering the presence of clinical signs of the disease, they were subdivided into two groups: Group I (n=42) - patients with exophthalmos without classical EOP symptoms with exophthalmometry in the range of ≥ 18 to ≤23mm; Group II (n = 48) - patients with exophthalmos accompanied by classical EOP symptoms, whose exophthalmometry was more than 23mm. Results. The indicators were revealed that characterize the anatomical features of the bone part of the orbital complex, with a deviation from which the risk of developing exophthalmos is much higher and its clinical manifestation, associated with changes in intraorbital structures (thickness and density of muscles and retrobulbar tissue), is much higher and more severe. Conclusions. The data obtained made it possible to develop an algorithm for diagnosing exophthalmos with image intensifier and to propose a set of rational organizational measures and diagnostic techniques for its timely detection and establishment of a clinical and functional diagnosis at the stage of outpatient and / or inpatient care, as well as substantiation of the treatment method.