甲状腺相关性眼病的临床特征

目的回顾性分析56例甲状腺相关性眼病(thyroid associated ophthalmopathy,TAO),提出TAO不典型病例的临床特征,为早期进行临床诊断提供依据.方法总结56例TAO患者的主诉、眼征、斜视度、眼球运动等临床特征和眼外肌的影像学检查结果,进行统计学分析.结果本组有94.7%的患者表现为眼球运动受限,83.9%的病例以复视为主诉就诊,53.6%出现眼球突出,46.4%出现眼睑退缩和迟落.TAO以多条眼外肌受累为特点,眼外肌厚度增加以上直肌最为明显,以上转运动受限频率最高(69.6%).本组TAO的发生先于甲状腺功能异常23人(41.1%),其中有9人(16.1%)是TAO发生1年以上才发生甲状腺功能异常的.结论大多数TAO患者依据其临床表现易于确诊,对不典型患者应注意眼征特点,分析眼外肌受累的情况,并排除其他原因引起的限制性斜视.牵拉试验和影像学检查对确诊有重大意义.

Clinical features of atypical thyroid associated ophthalmopathy

object To characterize atypical thyroid associated ophthalmopathy (TAO), 56 cases of TAO were analyzed retrospectively. Method clinical findings,including Chief complaints, deviation of strabismus, ocular movement, and thickness of extraocular muscles were statistically analyzed. Results Restriction of eye movement was found in 94.7% cases; diplopia, a chief complaint was found in 83.9% patients; the frequency of exophthalmos and retraction of upper lid were 53.6% and 46.4% respectively. TAO invariably affects each of the extraocular muscles, while limitation of elevation is usually the most commonly defect of ocular motility (69.6%). 23 patients (41.4%) were observed in whom TAO is present prior to thyroid morbidity, further more,in 9 of them (16.1%), thyroid abnormality occurred more than 1 year after the onset of TAO. Conclusion The diagnosis is easy to be established in most cases in TAO. While for atypical cases, the diagnosis is substantially based on character of ophthalmopathy and the situation of affected extraocular muscles. It is recommended to perform the forced duction test and medical image examination to confirm the diagnosis.