Diagnosis and treatment of upper eyelid retraction in thyroid-associated ophthalmopathy / 中华实验眼科杂志

ABSTRACT

Thyroid associated ophthalmopathy (TAO) is often shown as upper eyelid retraction,conjunctival hyperemia and edema,proptosis,diplopia,strabismus and decreased visual acuity.It is difficult to make a certain diagnosis in the early stage of TAO.Patients suffering from TAO often have upper eyelid retraction at the early stage of disease,which affects appearance and causes feelings of discomfort and decreased visual acuity.Learning more about upper eyelid retraction contributes to the early diagnosis and treatment of TAO.Although upper eyelid retraction with TAO has distinctive manifestations,it is easy to misdiagnose.The differential diagnosis includes congenital eyelid retraction,neurological disorders,high axial myopia,glaucoma filtering bleb,and so on.Family history,clinical manifestations and TAO related examinations should also be taken into consideration.Comprehensive treatments should be adopted.Glucocorticoids and eyelid retraction surgeries are current mainstay of treatment.There are controversies on the application of glucocorticoids about the specific dosage,while agreement achieved that the cumulative dose should not be more than 8 g in one stage in order to reduce the risk of liver failure and other adverse events.Different operation methods should be chosen according to the degrees of retraction and causes of disease for each type of patients.In addition,special attentions should be paid to the decrease of muscle strength in the temporal side.Individual analysis is needed in order to diagnose and treat upper eyelid retraction with TAO.Early diagnosis and intervention can improve the appearance,visual function and quality of life of the patients.