甲状腺相关眼病上睑退缩的诊断和治疗

Diagnosis and treatment of upper eyelid retraction in thyroid-associated ophthalmopathy

甲状腺相关眼病（TAO）常表现为上睑退缩、结膜充血水肿、眼球突出、复视、斜视、视力下降等，疾病早期确诊有一定困难。TAO患者往往在病程早期即出现上睑退缩，影响外观，造成不适感和视力减退，增加对上睑退缩的了解有助于TAO的早期诊治。TAO上睑退缩患者往往具有典型的横向耀斑征，即上睑颞侧退缩更明显，但仍容易漏诊，需与先天性上睑退缩、部分神经系统疾病、高度近视突眼、青光眼滤过泡等相鉴别，同时综合考虑患者家族史、临床表现和TAO相关的辅助检查以确诊。TAO上睑退缩宜采用综合治疗措施。推荐全身或局部糖皮质激素治疗或手术治疗。目前，应用糖皮质激素的具体剂量仍存在一定争议，但建议1个阶段的治疗中累积剂量不超过8g，否则易引起肝衰竭等不良反应的发生。根据患者病因和退缩程度的分级，应选择不同的手术方法，对各类型患者采取适合的治疗方案。另外，术中还应特别注意颞侧肌力的减弱。TAO上睑退缩的诊治常需个体化分析，早诊断、早治疗可有效改善患者的容貌外观和视功能，提高患者的生活质量。

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 he 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 glucoeortieoids 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.