Orbital venous return disorder

Introduction The systemic venous tube delivers blood back to the right atrium. The systemic venous system has a large blood volume, accounting for more than half of the total blood. The vein is easily dilated and can contract, thus acting as a blood storage stock. The contraction and relaxation of the vein can effectively regulate the amount of blood return and cardiac output, so that the circulation function can adapt to the needs of the body in various physiological states. The basic force of venous return is the pressure difference between the venule (also known as the peripheral vein) and the vena cava or right atrium (also known as the central vein). An increase in venule pressure or a decrease in vena cava pressure is beneficial for venous return. Since the venous wall is thin and the venous pressure is low, the venous return is also affected by external force such as muscle contraction, respiratory motion, gravity, and the like. When the above factors hinder venous return, the body will exhibit various manifestations. Long-term internal venous reflux disorder can also be secondary to open-angle glaucoma, with decreased vision and visual field defects.

Cause

Thyroid-associated ophthalmopathy (TCO) is one of the most common eyelid diseases in adults. It is an autoimmune disease and the exact pathogenesis is still unclear.

an examination

Related inspection

Eye and sacral area CT examination eye movement examination

1. Based on characteristic performance diagnosis

For example: according to the incidence of good eyes, eyeballs, eyelid retraction, late eyelid delay and other typical eyelid signs, eye movement restricted dysfunction (thyroid dysfunction history only for reference). Even if the thyroid function is normal, if it has the above performance, it can diagnose thyroid-related eye disease and closely detect thyroid function. In a small number of patients with thyroid-associated eye disease, when ptosis occurs, it should be checked whether the myasthenia gravis is combined. Both of them are immune diseases, which may be accompanied by glucocorticoids and immunosuppressive agents.

2. Ultrasound examination

Ultrasound can show the appearance of extraocular muscle thickening, which is a fusiform middle and low echo.

3. CT scan

Coronal CT can show that the extraocular muscles are thickened, and even a small number of patients can involve the superior and inferior oblique muscles. Axial CT can better show the thickening of the inner and outer rectus muscles, the inner bone of the iliac crest is thin, and the long-term sputum pressure is increased, causing the bone to sinus arcuate depression, bilateral symmetry, named "Coke bottle" sign. In the case of severe eyeballs, the optic nerve is pulled and loses its physiological curvature and is linear.

4. MRI examination

In addition to showing the same morphological changes as the CT scan, the signal changes in the extraocular muscles are associated with treatment. The extraocular muscles of the lesions showed moderate or low signal on T1WI, and the T2WI showed medium or low signal, indicating severe muscle fibrosis, hormonal shock therapy, chemotherapy or radiotherapy. The T2WI showed high signal, indicating that the muscle was in inflammatory edema. The above treatment is relatively sensitive.

Differential diagnosis

Myositis inflammatory pseudotumor

Acute onset, pain, eyelids, conjunctival congestion and edema, can be associated with ptosis, eye movement restricted, hormone shock or radiotherapy is more obvious. Imaging examination can show irregular swelling of the extraocular muscles, muscle at the same time, and thickening of the eye ring.

2. Intraorbital tumor

A variety of intraorbital tumors can cause eyeballs to stand out, and imaging studies can show round or fusiform masses in the iliac crest, which is highly confusing with a single hypertrophic thyroid-associated eye disease. However, the latter is more involved with both eyes, with typical eyelid signs and most patients with thyroid dysfunction.

3. The ptosis

When a monocular congenital, traumatic or secondary ptosis is gazing forward or upward, excessive nerve excitability is transmitted to the contralateral healthy eye, causing the upper palate to retreat and the palate to be too large, but no upper palate Fall, need to be differentiated from thyroid-related eye diseases.

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