Stelwag's symptom is one of the manifestations of hyperthyroidism. The disease is associated with an increase in the hormonal activity of the gland. With thyroid or endocrine ophthalmopathy (EOP), that is, "eye" symptoms of diffuse toxic goiter (DTG), eye symptoms occur in the clinical picture: Graefe, Moebius, Stelvag, Krauss, Kocher, Delrymple, Jellinek, less often Rosenbach, Botkin. Ophthalmic disorders occur in 20-91.4% of cases. The image intensifier can be light, medium and heavy in degrees.
Grefe's symptom
It is expressed in the fact that when looking down, the upper eyelid lags behind, and a strip of sclera becomes visible. This phenomenon occurs because the tone of the muscles that control the eyelid is increased, under the influence of an excess of T3 and T4 in the blood.
By the way, this symptom is not permanent. It can also occur in he althy people with myopia (nearsightedness).
Mobius symptom
Appears due to weakness of adductor eye muscles. At the same time, convergence weakens, and the person loses the ability to fix his gaze on nearby objects. It happens in he althy people.
Stellwag Syndrome
Stelvaga symptom is a rare blinking. Due to wrinkling (retraction) of the upper eyelid and protrusion of the eyeball, the impression of an increase in the palpebral fissure is created. This symptom of Stelwag, which often occurs with hyperthyroidism and is considered one of its manifestations, does not occur in all patients. In addition, a symptom can also occur in some brain diseases - Parkinson's disease, postencephalitic parkinsonism, akinetic-rigid syndrome (extrapyramidal phenomenon of parkinsonism), Bell's palsy. The description of this sign was made by an ophthalmologist from Austria, Karl Stelwag.
What is this symptom of Stelwag? This is a rare blinking (less than 3 times per minute), which is regarded as a sign of reduced sensitivity of the cornea. The patient's gaze looks motionless, frozen.
Why do these symptoms occur
Interpretation of eye symptoms is difficult because the mechanism is not fully understood. It was said that with pathologies of the thyroid gland inside the orbit, swelling of the muscles and soft tissues occurs. They push the eyeball forward and cause various eye symptoms - an additional cause.
Currently, it has been proven that exophthalmos is caused by pathological tone m. orbitalis (müllerian muscle). Therefore, the growth of retrobulbar fatty tissue,expansion of orbital veins and arteries does not play a role. This is evidenced by the absence of changes in the fundus.
Secondly, the main confirmation of this point of view is that exophthalmos can occur even in a few hours. This is due to irritation of the cervical sympathetic nerve. It causes a sharp reduction m.orbitalis. There is a covering behind the eyeball and, as it were, pushing it forward.
In addition, veins and lymphatic vessels pass through this muscle, and when the muscle suddenly contracts, they are squeezed, and the answer is swelling of the eyelids and retrobulbar space. Here is a more correct explanation of the pathogenesis. Bulging eyes with thyrotoxicosis may not appear, this also takes place.
Infrequent blinking (Stelwag's symptom), wide opening of the palpebral fissures (Delrymple's symptom), and a special shine of the eyes are due to increased muscle tone of the cartilage of the eyelids. And, finally, in hyperthyroidism, in addition to autoimmune inflammation of the eye, the activity of the sympathetic-adrenal system is increased. It, in turn, strengthens the tone of the muscles lifting the upper eyelid. But the full mechanism of neurohormonal disorders associated with eye symptoms has not been fully disclosed today.
Is their appearance mandatory
Not all eye symptoms of DTG can appear in one patient. More common than others:
- Graefe, Ekrot, Kocher, Dalrymple - with them, the function of the upper eyelid is impaired.
- Jaffe and Geoffroy's symptoms, Rosenbach's symptoms, Stellwag's symptom associated with neurogenicfactors.
- Moebius, Wilder symptoms due to eye convergence disorder.
But this does not mean that eye signs are required for goiter. They may be absent altogether. Therefore, it is wrong to consider them as a manifestation of the severity of DTG. In severe thyrotoxicosis, they may not occur.
Treatment
Why should eye symptoms be treated? The fact is that they not only change the appearance of the patient (worse it), but also disrupt vision, causing its decrease, conjunctivitis, subluxation of the eyeball, eye pain and discomfort. Effective therapy for precisely these symptoms has not been developed today.
Treatment of Stelwag's symptom and other eye manifestations gives results only in the active phase of goiter. When the inflammatory process subsides, it is sometimes necessary to resort to surgical intervention.
Treatment of eye symptoms is mainly pathogenetic during remissions. In other words, it is any eye protection. It can be medical, supportive physiology and surgical, even in the form of radiation. Artificial tear preparations are indicated for all patients ("Hilo-comod", "Vizomitin") or moisturizing gels ("Oftagel", "Korneregel").
But the main thing is the treatment of the goiter itself. Mild EOP usually does not require therapy. In moderate and severe forms, glucocorticoid steroids (Prednisolone, Metipred) and radiation therapy are used.
"Prednisolone" is prescribed for a long time and in high doses. As the condition improvesdoses are gradually reduced. More effective is the use of drugs parenterally, into a vein. It is carried out only permanently. Irradiation of the orbits is used only as an addition to medicines. Prevention of exophthalmos also lies in the timely treatment of thyrotoxicosis.
