Eye Symptoms in Parathyroid Disorders: Clinical Presentation and Research Perspectives
DOI:
https://doi.org/10.12775/QS.2025.39.58991Keywords
ocular, parathyroid, hyperparathyroidism, hypoparathyroidismAbstract
Introduction and purpose: Endocrine disorders often affect multiple organs, frequently presenting with characteristic ophthalmic symptoms. Ocular abnormalities occur in both hyperparathyroidism and hypoparathyroidism, potentially affecting nearly all parts of the eyeball and orbital structures. This study aims to summarize available literature and recent findings on ophthalmic manifestations linked to parathyroid disorders.
Material and methods: A comprehensive literature review was conducted using keywords in the PubMed database, the Via Medica journal database, the Polish Society of Endocrinology guidelines, and the Polish Ophthalmological Society guidelines.
State of knowledge: Ophthalmic manifestations are common in parathyroid disorders. Hypoparathyroidism often causes cataracts, periorbital tetany, blepharospasm, and optic nerve issues, while congenital cases may involve microphthalmia and corneal opacities. Hyperparathyroidism leads to calcium deposition, affecting retinal arterioles, sclera, eyelids, and cornea, with reports of scleritis and orbital brown tumors.
Summary: Recognizing ocular signs of parathyroid diseases aids in diagnosing endocrine disorders and highlights the need for ophthalmological consultation to improve early detection and treatment.
References
[1] M. H. Nowroozzadeh, S. Thornton, A. Watson, Z. A. Syed, and R. Razeghinejad, “Ocular manifestations of endocrine disorders.,” Clin Exp Optom, vol. 105, no. 2, pp. 105–116, Mar. 2022, doi: 10.1080/08164622.2021.1986354.
[2] Z. Liu, Y. Chen, Z. Lin, and X. Shi, “Ophthalmic clues to the endocrine disorders,” J Endocrinol Invest, vol. 40, no. 1, pp. 21–25, Jan. 2017, doi: 10.1007/s40618-016-0532-7.
[3] A. M. Hendrick, M. Y. Kahook, Y. J. Daoud, and R. Hazin, “Ophthalmic manifestations of endocrine disorders: Approaches and medical management,” Current Opinion in Ophthalmology, vol. 20, no. 6. pp. 495–503, Nov. 2009. doi: 10.1097/ICU.0b013e328331903c.
[4] A. Grzybowski, “Okulistyka,” 2nd ed., Edra Urban & Partner , 2023, pp. 12–21.
[5] B. D. Kels, A. Grzybowski, and J. M. Grant-Kels, “Human ocular anatomy,” Clin Dermatol, vol. 33, no. 2, pp. 140–146, Mar. 2015, doi: 10.1016/j.clindermatol.2014.10.006.
[6] W. Misiorowski et al., “Management of hypoparathyroidism: a Position Statement of the Expert Group of the Polish Society of Endocrinology,” Endokrynol Pol, vol. 74, no. 5, pp. 447–467, 2023, doi: 10.5603/ep.96950.
[7] B. C. Silva, “Skeletal and nonskeletal consequences of hypoparathyroidism,” Archives of Endocrinology and Metabolism, vol. 66, no. 5. Sociedade Brasileira de Endocrinologia e Metabologia, pp. 642–650, 2022. doi: 10.20945/2359-3997000000553.
[8] J. L. Pasieka et al., “Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review,” Journal of Bone and Mineral Research, vol. 37, no. 12, pp. 2586–2601, Dec. 2022, doi: 10.1002/jbmr.4714.
[9] A. M. Hendrick, M. Y. Kahook, Y. J. Daoud, and R. Hazin, “Ophthalmic manifestations of endocrine disorders: Approaches and medical management,” Current Opinion in Ophthalmology, vol. 20, no. 6. pp. 495–503, Nov. 2009. doi: 10.1097/ICU.0b013e328331903c.
[10] S. Pohjola, “OCULAR MANIFESTATIONS OF IDIOPATHIC HYPOPARATHYROIDISM: Case report and review of literature,” Acta Ophthalmol, vol. 40, no. 3, pp. 255–265, 1962, doi: 10.1111/j.1755-3768.1962.tb02365.x.
[11] F. Cherchir et al., “Long-term complications of permanent hypoparathyroidism in adults: prevalence and associated factors.,” Endocrine, Mar. 2024, doi: 10.1007/s12020-024-03765-9.
[12] R. Goswami, R. Sharma, V. Sreenivas, N. Gupta, A. Ganapathy, and S. Das, “Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism,” Clin Endocrinol (Oxf), vol. 77, no. 2, pp. 200–206, Aug. 2012, doi: 10.1111/j.1365-2265.2012.04353.x.
[13] T. Vadiveloo, P. T. Donnan, C. J. Leese, K. J. Abraham, and G. P. Leese, “Increased mortality and morbidity in patients with chronic hypoparathyroidism: A population-based study,” Clin Endocrinol (Oxf), vol. 90, no. 2, pp. 285–292, Feb. 2019, doi: 10.1111/cen.13895.
[14] L. Underbjerg, T. Sikjaer, L. Mosekilde, and L. Rejnmark, “The epidemiology of nonsurgical hypoparathyroidism in Denmark: A nationwide case finding study,” Journal of Bone and Mineral Research, vol. 30, no. 9, pp. 1738–1744, Sep. 2015, doi: 10.1002/jbmr.2501.
[15] L. Underbjerg, T. Sikjaer, L. Mosekilde, and L. Rejnmark, “Postsurgical hypoparathyroidism-Risk of fractures, Psychiatric Diseases, Cancer, Cataract, and Infections,” Journal of Bone and Mineral Research, vol. 29, no. 11 S1, pp. 2504–2510, Feb. 2014, doi: 10.1002/jbmr.2273.
[16] S. Saha, S. P. Gantyala, S. Aggarwal, V. Sreenivas, R. Tandon, and R. Goswami, “Long-term outcome of cataract surgery in patients with idiopathic hypoparathyroidism and its relationship with their calcemic status,” J Bone Miner Metab, vol. 35, no. 4, pp. 405–411, Jul. 2017, doi: 10.1007/s00774-016-0767-6.
[17] P. Gajewski, “Interna Szczeklika 2023,” Kraków: Wydawnictwo Medycyna Praktyczna, 2023.
[18] V. Kumar, A. K. Abbas, and J. C. Aster, “Robbins Basic Pathology,” 10th ed., Elsevier , 2017, pp. 769–772.
[19] S. Minisola et al., “Epidemiology, Pathophysiology, and Genetics of Primary Hyperparathyroidism,” Journal of Bone and Mineral Research, vol. 37, no. 11. John Wiley and Sons Inc, pp. 2315–2329, Nov. 01, 2022. doi: 10.1002/jbmr.4665.
[20] J. A. Urrets-Zavalía et al., “The eye and the skin in endocrine metabolic diseases,” Clin Dermatol, vol. 34, no. 2, pp. 151–165, Mar. 2016, doi: 10.1016/j.clindermatol.2015.12.001.
[21] R. Chopra, A. Chander, and J. Jacob, “The eye as a window to rare endocrine disorders,” Indian J Endocrinol Metab, vol. 16, no. 3, p. 331, 2012, doi: 10.4103/2230-8210.95659.
[22] P. Finny, J. J. Jacob, and N. Thomas, “Primary hyperparathyroidism presenting as redness of eyes.,” Eur J Intern Med, vol. 18, no. 8, p. 608, Dec. 2007, doi: 10.1016/j.ejim.2007.03.005.
[23] A. K. Gündüz and D. Tetik, “Diagnosis and Management Strategies in Sclerochoroidal Calcification: A Systematic Review.,” Clin Ophthalmol, vol. 17, pp. 2665–2686, 2023, doi: 10.2147/OPTH.S399058.
[24] C. Uysal, T. Yilmaz, H. Ozkan, O. Canoz, and B. Tokgoz, “The refractory secondary hyperparathyroidism presenting with retro-orbital brown tumor: a case report.,” BMC Nephrol, vol. 25, no. 1, p. 15, Jan. 2024, doi: 10.1186/s12882-024-03455-8.
[25] D. F. A. Cecchetti et al., “Orbital involvement in craniofacial brown tumors.,” Ophthalmic Plast Reconstr Surg, vol. 26, no. 2, pp. 106–11, 2010, doi: 10.1097/IOP.0b013e3181b8e3ec.
[26] V. Jhanji, C. J. Rapuano, and R. B. Vajpayee, “Corneal calcific band keratopathy.,” Curr Opin Ophthalmol, vol. 22, no. 4, pp. 283–9, Jul. 2011, doi: 10.1097/ICU.0b013e3283477d36.
[27] G. R. O’Connor, “Calcific band keratopathy.,” Trans Am Ophthalmol Soc, vol. 70, pp. 58–81, 1972.
[28] P. Abeysiri and A. Sinha, “An unusual pattern of corneal calcification in tertiary hyperparathyroidism.,” Arch Ophthalmol, vol. 124, no. 1, pp. 138–9, Jan. 2006, doi: 10.1001/archopht.124.1.138.
[29] J. W. Berkow, B. S. Fine, and L. E. Zimmerman, “Unusual ocular calcification in hyperparathyroidism,” Am J Ophthalmol, vol. 66, no. 5, pp. 812–824, 1968, doi: 10.1016/0002-9394(68)92795-5.
[30] F. B. WALSH and R. G. MURRAY, “Ocular manifestations of disturbances in calcium metabolism.,” Am J Ophthalmol, vol. 36, no. 12, pp. 1657–76, Dec. 1953, doi: 10.1016/0002-9394(53)90001-4.
[31] R.-L. Jan, J.-J. Wang, S.-H. Tseng, and Y.-S. Chang, “Sociodemographic Factors and Comorbidities Including Hyperparathyroidism Are Associated With an Increased Risk of Band Keratopathy: A Population-Based Study in Taiwan.,” Front Endocrinol (Lausanne), vol. 13, p. 927513, 2022, doi: 10.3389/fendo.2022.927513.
[32] M. Petrohelos, D. Ticoulis, and P. Diamantacos, “Band keratopathy with bilateral deafness as a presenting sign of hyperparathyroidism.,” Br J Ophthalmol, vol. 61, no. 7, pp. 494–5, Jul. 1977, doi: 10.1136/bjo.61.7.494.
[33] R. Porter and A. L. Crombie, “Corneal calcification as a presenting and diagnostic sign in hyperparathyroidism.,” Br J Ophthalmol, vol. 57, no. 9, pp. 665–8, Sep. 1973, doi: 10.1136/bjo.57.9.665.
[34] S. Sood and S. Friedman, “Sclerochoroidal Calcification with Optic Nerve Calcification in a Patient with Primary Hyperparathyroidism and Severe Vision Loss.,” Retin Cases Brief Rep, Mar. 2023, doi: 10.1097/ICB.0000000000001418.
[35] S. Y. Cohen, M. Guyot-Sionnest, and M. Puech, “Choroidal neovascularization as a late complication of hyperparathyroidism.,” Am J Ophthalmol, vol. 126, no. 2, pp. 320–2, Aug. 1998, doi: 10.1016/s0002-9394(98)00160-3.
[36] J. A. Shields and C. L. Shields, “CME review: sclerochoroidal calcification: the 2001 Harold Gifford Lecture.,” Retina, vol. 22, no. 3, pp. 251–61, Jun. 2002, doi: 10.1097/00006982-200206000-00001.
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Copyright (c) 2025 Karol Zagórski, Nina Skalska-Dziobek, Przemysław Cetnarowski, Mateusz Kozik, Weronika Małagocka, Karolina Chybowska, Maria Naruszewicz
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