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      Prof. Chantal Daumerie

      Service d’Endocrinologie et de Nutrition, Université Catholique de Louvain

      Cliniques Universitaires Saint-Luc

      Avenue Hippocrate 54, UCL 54.74

      BE–1200 Brussels (Belgium)

      E-Mail [email protected]

       Diagnosis and Pathogenesis

      Wiersinga WM, Kahaly GJ (eds): Graves’ Orbitopathy: A Multidisciplinary Approach – Questions and Answers.

       Basel, Karger, 2017, pp 41–60 (DOI: 10.1159/000475948)

      ___________________

Pathogenesis

      Mario Salvi^a · Utta Berchner-Pfannschmidt^b · Marian Ludgate^c

      ^aGraves’ Orbitopathy Center, Department of Endocrinology, Fondazione Cà Granda IRCCS, University of Milan, Milan, Italy; ^bMolecular Ophthalmology, Department of Ophthalmology, University of Duisburg-Essen, Essen, Germany; ^cDivision of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK

What Are the Pathological Changes in Orbital Tissue in Graves’ Orbitopathy?

      The pathological processes within the orbit include:

      •inflammatory infiltration of retro-ocular tissues within the orbit;

      •expansion of the adipose tissue within the connective tissue located in (endomysium) and around (perimysium) the eye muscles and the fatty connective tissue which fills the intermuscular space;

•excess production by orbital fibroblasts of glycosaminoglycans (GAGs) resulting in an increase in the volume of the extraocular muscles and orbital fat/connective tissue (Fig. 1).

Orbit imaging shows a variable balance among patients between muscle enlargement (the most frequent abnormality observed) and expansion of orbital fat/connective tissue (Fig. 2). Preferential expansion of adipose tissue has been described in patients below 40 years of age, as has a predominant enlargement of extraocular muscles in older individuals with Graves’ orbitopathy (GO) [1].

Muscles may reach 2–3 times the normal volume, sometimes at the expense of the orbital fat tissue volume [2]. The inferior rectus muscle is predominantly affected, followed by the medial rectus, with the other muscles often being spared. Only the belly part of the muscles is affected, and the tendons remain unchanged, which differentiates

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