Ophthalmic manifestations of endocrine disorders-endocrinology and the eye

Abstract

Disorders of the endocrine system usually manifest in a multi-organ fashion. More specifically, many endocrinopathies become apparent in the eye first through a variety of distinct pathophysiologic disturbances. The eye provides physicians with valuable clues for the recognition and management of numerous systemic diseases, including many disorders of the endocrine pathway. Recognizing ophthalmic manifestations of endocrine disorders is critical not only for rapid diagnosis and treatment, but also to prevent significant morbidity and mortality. In this review, we discuss relevant ophthalmic findings associated with key disorders of the pancreas, thyroid gland, and hypothalamic-pituitary axis, as well as with multiple hereditary endocrine syndromes. We have chosen to focus on diabetes mellitus (DM), Graves' ophthalmopathy, pituitary tumors, and some less common disorders that underscore the unique relationship between the eye and the endocrine system.

Keywords: Endocrine disease; Graves’ ophthalmopathy; diabetes mellitus (DM); eye disease; hypothalamic-pituitary axis; review; window.

Figure 1

Fundus photograph of the right eye depicting mild non-proliferative diabetic retinopathy, with a normal appearing optic nerve and retinal vasculature, and scattered microaneurysms, dot-blot hemorrhages and exudates (8).

Figure 2

Fundus photograph of the left eye depicting severe proliferative diabetic retinopathy, with diffuse dot-blot hemorrhages, exudates, and marked neovascularization of the disc and retina along both the superior and inferior arcades (9).

Figure 3

Fundus photograph of the left eye depicting uncontrolled proliferative diabetic retinopathy with extensive pan-retinal neovascularization of the optic disc and posterior pole (9).

Figure 4

Fundus photograph of the left eye depicting a fovea-threatening tractional retinal detachment due to untreated proliferative diabetic retinopathy. Retinal neovascularization extends into the vitreous, creating fibrovascular scaffolds that can subsequently detach the retina from the underlying retinal pigment epithelium (10).

Figure 5

Photograph of an individual with Graves’ ophthalmopathy demonstrating exophthalmos and the classic “wide-eyed stare” (39).

Figure 6

Computed tomography scan (axial view) showing enlargement of the medial rectus muscle bilaterally (right greater than left) secondary to Graves’ ophthalmopathy. Note the pathognomonic enlargement of the muscle belly with relative sparing of the muscle tendon (40).

Figure 7

Schematic representation of the anatomy of the retinal nerve fibers, and corresponding segments of the optic nerves and tracts as they course toward the visual cortex, located within the occipital lobes (46).

Figure 8

T2-weighted magnetic resonance image (coronal view) showing an absent septum pellucidum, as depicted by the arrow-head, in a patient with septo-optic dysplasia (50).

Figure 9

Fundus photographs from a patient with right ONH and a normal left optic nerve (55).

Figure 10

Slit lamp image of the anterior segment of an individual with neurofibromatosis type 1 demonstrating numerous Lisch nodules, seen as yellow-brown masses on the surface of the iris stroma (73).