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PubMed1998

Bilateral supernumerary rectus muscles of the orbit.

A bilateral anomaly of the rectus muscles and a unilateral variation of the levator palpebrae muscle were found in the right and left orbits of an 84-year-old man. The anomaly was in the form of a supernumerary rectus muscle lying on a sagittal orientation between the optic nerve and lateral rectus muscle (in the right orbit) and adjacent to the inferior rectus muscle (in the left orbit). In each orbit the anomalous muscle originated occipitally from the common tendinous ring and frontally-near the eyeball-joined the terminal part of the inferior rectus. On its superior margin the anomalous muscle had, in the right orbit, a broad (4 mm), and in the left orbit a slender (2 mm) muscular bridge to the superior rectus muscle. Because of their connection to the superior rectus and their innervation by N.III the accessory orbital muscles are not deemed to be vestiges of the retractor bulbi muscle which, with the exception of the primates, is a typical occurrence in vertebrates and is always innervated by N.VI. Our anomalous orbital muscle must be explained as a supernumerary rectus muscle. A further variation occurred in the right orbit: an isolated medial part or belly of the levator palpebrae muscle (the so-called M. gracillimus). In primates this variation is known as a remnant of the membrana nictitans (third eyelid of the amniotes). Ignorance of anomalies in the orbital muscles may lead to confusion and error in diagnostic identification and surgical exposure.

Aged↗

PubMed1994

Demonstration of thyrotropin binding sites in orbital connective tissue: possible role in the pathogenesis of thyroid-associated ophthalmopathy.

The thyrotropin (TSH) receptor is implicated in the pathogenesis of thyroid-associated ophthalmopathy, but its presence has not been demonstrated in orbital tissues. Binding of 125I-TSH to porcine orbital connective tissue and thyroid membranes was studied. At pH 7.4 125I-TSH bound to thyroid membranes with high affinity, but not to orbital connective tissue membranes. At pH 5.2, binding of 125I-TSH was evident on thyroid and orbital connective tissue membranes, although of low affinity. Low affinity binding at pH 5.2, could also be demonstrated on orbital fibroblasts; binding to membranes prepared from extraocular muscle, or from abdominal adipose tissue was not detected. Immunoglobulin G from healthy subjects (n = 17) and patients with ophthalmopathy (n = 19) were tested for inhibition of 125I-TSH binding to membranes. As anticipated patients' IgG exhibited greater inhibition than normal controls with thyroid membranes at pH 7.4 (p < 0.001). Similar results were obtained with thyroid membranes (p < 0.05), and orbital connective tissue membranes at pH 5.2 (p < 0.001). Significant correlations were found when percentage inhibition by IgG was compared between: thyroid membranes at pH 7.4 and thyroid membranes at pH 5.2, orbital connective tissue membranes at pH 5.2 and thyroid membranes at pH 7.4, and orbital connective tissue membranes at pH 5.2 and thyroid membranes at pH 5.2. A low affinity TSH-binding site is present in orbital connective tissue, and is recognized by IgG's from patients with ophthalmopathy which suggests that TSH receptor antibodies may target the orbit.

Adolescent↗

PubMed2004

[Lateral orbital decompression for Graves' orbitopathy. Indication, surgical technique, and treatment success].

PURPOSE: In Graves' disease a discrepancy between volume increase of the orbital soft tissues and fixed volume of the orbital cavity leads to exophthalmos. The patients do not only feel cosmetically disfigured, they often complain about more or less painful retroorbital pressure sensation or show symptoms of compressive optic neuropathy or corneal exposure because of a significant lid lag. To solve this problem, different orbital decompression techniques have been developed. This is to report about our results with a modified Dollinger technique for lateral orbital decompression. PATIENTS AND METHODS: A total of 27 patients aged 19-76 years (mean: 45.1 years) with Grave's ophthalmopathy were recorded who had undergone orbital decompression by a lateral approach between June 1999 and April 2003. The modified Dollinger technique was performed by deepening the osteotomy to the level of the sphenoid wing and by additional resection of intraconal fat. RESULTS: The reduction of exophthalmos achieved after decompressive surgery averaged 2.9 +/- 1.1 mm. Of the patients whose indication for orbital decompression was a compressive neuropathy, the visual acuity improved postoperatively for 3 lines. Of the 16 patients with preoperative retrobulbar pressure sensation, 12 had no complaints after the operation. Remarkably no significant impairment of the ocular motility resulted after surgery. CONCLUSIONS: Decompression of the orbit by the modified Dollinger technique is a safe and effective approach to reduce exophthalmos, retrobulbar pressure sensation, and compression neuropathy as a result of diffusely elevated orbital tissue tension. In the case of direct compression of the optic nerve in the orbital apex, additional medial orbital wall decompression has to be considered.

Adult↗

PubMedDate not supplied

Clinical manifestations and management of orbital mucoceles: the role of ophthalmologists.

PURPOSE: To report the clinical features of orbital mucoceles and discuss the role of ophthalmologists in the management of patients with orbital mucoceles. METHODS: A retrospective chart review was performed of all patients with orbital mucoceles treated at the National Taiwan University Hospital from 1990 through 2002. The basic profiles, clinical features, and the management of the patients with orbital mucoceles were recorded and analyzed. RESULTS: The records of a total of 15 patients (aged 22 to 76, mean 45.5 years) with orbital mucoceles were selected for this study. The initial presentations included proptosis in ten patients (66.7%), diplopia in five (33.3%), ocular movement limitation in four (26.7%), periorbital pain in four (26.7%), palpable mass lesion in four (26.7%), ptosis in three (20.0%), decreased visual acuity in three (20.0%), headache in two (13.3%), and pupil abnormality with relative afferent papillary defect in one (6.67%). Of the 15 patients, the origins of the orbital mucocele were in the frontoethmoidal sinus in six (40.0%), the ethmoidal sinus in three (20.0%), the frontal sinus in three (20.0%), the maxillary sinus in one (6.7%), and the sphenoidal sinus in two (13.3%). The transcaruncular approach for the management of orbital mucoceles was performed in eight cases, the Lynch approach in three cases, the transforniceal approach in two cases, and functional endoscopic sinus surgery in one case. After surgery, no recurrence was noted. CONCLUSIONS: The frontoethmoidal sinus was the commonest origin of an orbital mucocele, and proptosis was the most frequent sign in patients with an orbital mucocele. All cases showed a favorable response to surgical intervention, and the transcaruncular approach may offer a good surgical option for the management of orbital mucoceles, especially for ophthalmologists.

Adult↗

PubMed1994

Orbital emphysema: case reports and review of the literature.

OBJECTIVE: This study was designed to describe the usual clinical findings of orbital emphysema as well as unusual and infrequent but important causes of this condition. DESIGN: We present seven detailed cases of orbital emphysema and review the pertinent English-language literature published since 1900. MATERIAL AND METHODS: Characterization of the seven patients with orbital emphysema illustrates the various causes and clinical findings of the disorder. Additionally, we review 78 previously published cases of orbital emphysema to determine the treatment and prognosis of this condition. RESULTS: Trauma is the most frequent cause of orbital emphysema; however, orbital emphysema also may occur spontaneously or as a complication of pulmonary barotrauma, infection, and operation. In most cases, orbital emphysema resolves spontaneously without compromising ocular function. If excessive amounts of air accumulate within the orbit, however, complications such as occlusion of the central retinal artery or compressive optic neuropathy may lead to loss of vision if not recognized promptly and treated. CONCLUSION: In most cases, orbital emphysema is an incidental, benign finding that resolves with time. Careful observation is the only treatment necessary unless an orbital fracture involves an infected sinus, in which case prophylactic orally administered antibiotics may be prescribed.

Adolescent↗

PubMed1993

Orbital infarction syndrome.

BACKGROUND: The authors define orbital infarction as ischemia of all intraorbital and intraocular structures. It is a rare disorder due to the rich anastomotic vascularization of the orbit. PATIENTS: The authors report three patients with orbital infarction with similar clinical presentations: acute blindness, orbital pain, total ophthalmoplegia, and anterior and posterior segment ischemia. RESULTS: Etiologies of orbital infraction syndrome include occlusion of the common carotid artery (case 1), giant-cell arteritis (case 2), and mucormycosis (case 3). CONCLUSION: Three cases discussed in this article illustrate that orbital infarction is a disorder that can occur secondary to different mechanisms such as (1) acute perfusion failure (e.g., common carotid artery occlusion [possibly combined with anomalous orbital anastomotic channels]), 2) systemic vasculitis (e.g., giant-cell arteritis), and (3) orbital cellulitis with vasculitis (mucormycosis). The blindness and retinal and optic nerve damage were permanent, whereas the other signs of orbital ischemia (ophthalmoplegia and anterior segment ischemia) resolved. Therefore, diagnosis of orbital infarction can best be made during the acute phase.

Aged↗

PubMed1999

An investigation into the mechanism of orbital blowout fractures.

For over a century, since the first description of an orbital 'blowout' fracture, there has been debate and confusion regarding the mechanism of production of these fractures. An orbital blowout fracture throughout this paper refers to fractures exhibiting displacement of the orbital floor or walls without an associated fracture of the orbital rim. These are the so called 'pure' blowout fractures as described by Converse. Involvement of the orbit in a variety of facial fracture patterns is easily explained on anatomical grounds. The orbital blowout fracture and symptom complex are readily recognisable but explanation of the mechanisms involved is not easily apparent. Experimental and clinical studies have generally aimed to support one or other of two proposed mechanisms. The 'buckling' theory contends that the fracture is produced as a result of transmission of force to the orbital floor from a blow to the orbital rim (Fig. 1). The 'hydraulic' theory differs in suggesting the force is transmitted to the floor via a direct blow to the globe (Fig. 2). Review of the literature reveals that there are major flaws in the design and execution of previous experimental methods. Most studies have incorporated some or all of the following limitations: low numbers, unquantified forces, non human models, incomplete soft tissues, poor simulation of in vivo conditions and a failure to isolate the position of the striking force. No study has ever provided a direct comparison between the two mechanisms under identical conditions. We present the results of such a study undertaken on 47 fresh cadaver orbits using the same quantifiable force and under the same experimental conditions. The results demonstrate that the efforts to establish either mechanism as the primary aetiology have been misplaced. Both mechanisms produce orbital blowout fractures. The fractures produced, however, are fundamentally different in their size, position and likely clinical significance.

Aged↗

PubMed1992

[Orbital involvement in Wegener's granulomatosis].

BACKGROUND: Granulomas of the orbit can complicate Wegener's granulomatosis (WG). If they compress the optic nerve, blindness of one or both eyes may result. Therefore, early detection and sufficient treatment are important. MATERIAL AND METHODS: Computed tomography (CT) and magnetic resonance imaging (MRI) of the orbit and CNS were performed in patients suffering from WG and orbital granulomas (n = 6). The patients were seen interdisciplinary by internists, ENT-specialists, radiologists and ophthalmologists. RESULTS: 12 out of 121 biopsy proven WG-patients showed orbital granulomas during their disease process. Granulomas of the orbit could be best visualized by MRI. However, MRI and CT taken together were most informative. 6 patients with orbital granulomas are presented as case reports, in four of them WG lead to blindness of one eye. The course of orbital granulomas may be chronic progressive or acutely fulminant. Therapy of first choice is a high dosage, long-term immunosuppression with cyclophosphamide and prednisolone. CONCLUSIONS: The detection of orbital granulomas in WG is most successful using CT and MRI. In addition to that, the analysis of visual acuity and visual field are the most important parameters in the detection and follow-up of orbital granulomas. A high dosage, long-term immunosuppression is the treatment of first choice, but in rapidly progressive cases an early decompression of the orbit has to be discussed additionally.

Abscess↗

PubMed2001

Identification of thyroglobulin in orbital tissues of patients with thyroid-associated ophthalmopathy.

Thyroid-associated ophthalmopathy (TAO) is thought to have an autoimmune pathogenesis because of its association with autoimmune thyroid disease, in particular with Graves' disease. Nevertheless, the nature of the autoimmune reaction is unclear, and a target orbital autoantigen has not been conclusively identified. A widely discussed hypothesis is that antigens constitutively shared by the thyroid and orbital tissues are targets of an autoimmune reaction. It has been also postulated that a thyroid-soluble antigen, namely thyroglobulin (Tg), is transported to orbital tissues through the lymphatics, where it accumulates and elicits autoimmune damages in susceptible individuals. Here we have investigated whether Tg is present in orbital tissues from patients with TAO. Retrobulbar tissue specimens were obtained from three patients with Graves' disease and TAO who underwent decompressive orbitotomy, and at autopsy from two patients with no thyroid or eye disease. All patients with TAO had been previously treated with radioiodine to control Graves' hyperthyroidism. Western blot analysis with a monoclonal anti-Tg antibody showed the presence of intact Tg, both in soluble and membrane-associated fractions of orbital tissue extracts from the patients with TAO, in amounts estimated to range from approximately 320 to approximately 900 pg/microg of tissue protein. In contrast, Tg was not detected in orbital tissue extracts from patients with no thyroid or eye disease. Tg was also demonstrated in orbital tissue extracts from two of three patients with TAO by enzyme-linked immunosorbent assay (ELISA), in amounts estimated to range from approximately 450 to approximately 1000 pg/microg of protein. In addition, Tg in orbital tissue extracts from patients with TAO was immunoprecipitated by a rabbit anti-Tg antibody, suggesting that it retained its native conformation. An anti-thyroxine (T4) antibody captured in solid-phase Tg from orbital tissue extracts, showing that it contained thyroid hormone residues and had therefore originated in the thyroid. Tg-anti-Tg immune complexes were not found in orbital tissues, suggesting that if an autoimmune reaction to Tg occurs in TAO, it is likely to be cell mediated.

Aged↗

PubMed2002

Orbital gallium-67 scintigraphy in Graves' ophthalmopathy.

Assessment of orbital disease activity in patients with Graves' ophthalmopathy is important in planning the therapeutic approach. In this study, orbital uptake of gallium-67 citrate ((67)Ga) was evaluated in 46 consecutive patients demonstrating active or inactive Graves' ophthalmopathy. The disease activity with Graves' ophthalmopathy was evaluated by using clinical activity score (CAS). Orbital (67)Ga scintigraphies of 8 patients without any history of ophthalmic, thyroid, or autoimmune disease were studied as controls. (67)Ga scintigraphy was performed 48 hours after intravenous injection of 4 mCi (128 MBq) of radioactive complex. Single-photon emission computed tomography (SPECT) images were obtained with a gamma camera. Intravenous corticosteroid treatment was given to 8 selected patients demonstrating bilateral active orbital disease and (67)Ga scintigraphy was repeated 6 months after the treatment. Quantitative analysis of mean orbital (67)Ga uptake demonstrated significant difference between active, inactive, and control groups (p = 0.0001). The orbital uptake of (67)Ga was significantly elevated in the active group compared to the inactive and control groups. A threshold orbital (67)Ga uptake value was calculated to differentiate active and inactive groups based on receiver operating characteristic (ROC) analysis. A significant correlation was found between the CAS and the (67)Ga orbital uptake (r = 0.73, p = 0.0001). Clinical improvement and significant decrease in orbital (67)Ga uptake were achieved after immunosuppressive treatment (p = 0.0004). These preliminary results suggest that orbital (67)Ga scintigraphy may provide objective assessment of the disease activity in Graves' ophthalmopathy.

Adult↗

PubMed1999

Surgical treatment for greater sphenoid wing fracture (orbital blow-in fracture).

The authors present 2 patients with greater sphenoid wing fractures that were treated surgically. This type of fracture is classified as a blow-in fracture of the lateral orbital wall. The first patient was a 16-year-old boy who was involved in a motor vehicle accident. Computed tomography (CT) disclosed a medial displacement of the inner wall of the greater sphenoid wing of the left orbit. He was unconscious for 3 days. After he recovered consciousness, he presented limited abduction of the left eye with diplopia in all gaze directions and mild left proptosis. Although these symptoms did not improve for 1 week, displaced bone fragments of the greater sphenoid wing were removed via the lateral orbital approach. The patient had a good postoperative course with progressive improvement in eye movement over the next several weeks. The second patient was a 22-year-old man whose face was hit in a fight. CT disclosed medial displacement of the inner wall of the greater sphenoid wing of the left orbit. Although the patient also presented limited abduction of the left eye on admission, this symptom improved gradually. However, diplopia in all gaze directions and mild left proptosis did not improve. Therefore, the displaced inner wall of the greater sphenoid wing was reduced via the lateral orbital approach. The patient showed a good postoperative course with progressive improvement over the next several weeks. This type of orbital fracture, which is classified as an orbital blow-in fracture, is relatively rare. This type of greater sphenoid wing fracture is caused by buckling of the orbital wall secondary to severe compression of the orbital rim. Surgical treatment using the lateral orbital approach through a hemicoronal skin incision afforded a wider operative field and better cosmetic result.

Adolescent↗

PubMed2002

Safety of titanium mesh for orbital reconstruction.

During the past several decades, the standard of care for orbital reconstruction after trauma has been autogenous bone grafts. Complications of bone grafts, including donor site morbidities such as scar alopecia and graft resorption with delayed enophthalmos, have inspired an interest in the use of alloplastic substitutes such as titanium. Titanium's role in orbital reconstruction was limited originally to small orbital defects, and as an adjunct to bone grafts. More recently, clinical studies have documented the sole use of titanium mesh to reconstruct large orbital defects. This study sought to document further the safety and efficacy of titanium mesh in reconstructing large orbital defects after facial trauma, with more extensive follow-up compared with previous studies. In the current study, 55 patients with 67 orbital fractures underwent orbital reconstruction with titanium mesh over a 5-year period. Associated fractures were reduced anatomically and fixed rigidly. For the analysis, 44 patients with 56 orbital fractures had adequate follow-up (mean, 44 months). An abscess developed in one patient who received high-dose steroids for 72 hours before reconstruction. She was treated with broad-spectrum intravenous antibiotics and bedside incision and drainage, and did not require removal of the titanium mesh. No patient in the current series required removal of the titanium mesh. A single case of uncorrected enophthalmos was treated with bone grafting rather than mesh revision. Large orbital defects can be reconstructed using titanium mesh with good functional results and minimal risk for infection. This study covered the authors' first 5 years using titanium. They have now used titanium mesh in orbital reconstructions for more than 10 years, without any additional cases of infection.

Adolescent↗

PubMed1990

Hypoglobus following orbital decompression for dysthyroid ophthalmopathy.

Hypoglobus following orbital decompression is not a rare complication. Hypoglobus requiring surgery to elevate the globe following orbital decompression is considered clinically significant hypoglobus. A retrospective analysis of 157 consecutive patients who had their orbits expanded by removing the medial wall and floor of the orbit found seven patients (4.5%) who required further surgery to elevate the globe. The seven patients who developed clinically significant hypoglobus following orbital decompression all developed a set of distinct clinical signs. These included a "setting sun" appearance of the globe, eyelid malposition, orbital volume loss, and strabismus. These clinical signs can be explained by the inferior movement of the globe and the orbital contents following the loss of support structures on the orbital floor. A two-wall orbital decompression performed on a cadaver reproduced the physical signs of hypoglobus. The dissection suggested that the periorbita is the most important structure supporting the globe in the orbit.

Exophthalmos↗

PubMed1991

Reconstruction of internal orbital fractures with Vitallium mesh.

Trauma to the face frequently results in internal orbital fractures that may produce large orbital defects involving multiple walls. Accurate anatomic reconstruction of the bony orbit is essential to maintain normal appearance and function of the eye following such injuries. Autogenous bone grafts do not always produce predictable long-term support of the globe. Displacement and varying amounts of bone-graft resorption can lead to enophthalmos. This study examines the use of Vitallium mesh in the acute reconstruction of internal orbital defects. Fifty-four patients with 66 orbits underwent reconstruction of internal orbital defects with Vitallium mesh. Associated fractures were anatomically reduced and rigidly fixed. Forty-six patients and 57 orbits had adequate follow-up for analysis of results. The average follow-up was 9 months, with 85 percent of the patients followed 6 months or longer. There were no postoperative orbital infections, and none of the Vitallium mesh required removal. Large internal orbital defects can be reconstructed using Vitallium mesh with good results and little risk of infection. Vitallium mesh appears to be well tolerated in spite of free communication with the sinuses. Stable reconstruction of the internal orbit can be achieved and predictable eye position maintained without donor-site morbidity.

Adolescent↗

PubMed1999

Endoscopically assisted reconstruction of orbital medial wall fractures.

Traditional surgical approaches to orbital medial wall fractures are either direct extraocular skin incisions or indirect bicoronal flap. However, these methods can leave remarkable orbital scars or scalp alopecia with the possible associated complications. A minimally invasive endoscopic technique with the assistance of a 2.7-mm, 30-degree telescope through a medial transconjunctival incision has been successfully used to reconstruct the orbital medial wall fractures. This technique was applied to four patients who had orbital medial wall fractures. Three patients also had concomitant orbital floor fractures. The other had associated superior orbital fissure syndrome. All patients were presented with limited eye movement, positive forced duction test, horizontal diplopia, and enophthalmos (3 mm to 6 mm) preoperatively. The entrapped periorbital tissues in the ethmoid sinus were completely reduced endoscopically. The bone defect of orbital medial wall was reconstructed with autogenous rib bone grafts under endoscopic control. The patients were followed up for 8 to 16 months with an average of 11 months. Three patients recovered completely without any residual eye symptoms after intervention. Clinically significant residual enophthalmos of 3 mm occurred in the patient with the superior orbital fissure syndrome. His eye movement limitation caused by entrapment of medial rectus muscle was relieved postoperatively. There was no donor-site morbidity or any complications related to the endoscopically assisted procedure. Endoscopically assisted medial transconjunctival approach to the orbital medial wall fractures is an excellent adjunct for the exposure and complete reduction of herniated periorbital tissue and bony reconstruction of the medial orbital wall.

Adult↗

PubMed2005

Corneal topography in thyroid orbitopathy after orbital irradiation.

PURPOSE: The orbital tonus changes in thyroid orbitopathy, so it may be expected that corneal topographic results also change. Orbital irradiation may reduce the orbital tonus, and thus, it may affect the topographic changes. Corneal topographic results were examined before and after orbital irradiation in patients with thyroid orbitopathy to determine whether there was a difference. METHODS: Twenty eyes of 10 patients with thyroid orbitopathy were included in this study. Corneal topography was performed with Topographic Modeling System 2 (Tomey). The refractive power of the corneal curvature was measured at the center of the corneal apex and in each of the eight quadrants, 1.5 mm and 3 mm from the corneal apex, on the corneal topographer. A total dose of 20 Gy was given in 10 fractions over 2 weeks to the orbital structures sparing the lens, and corneal topography was performed 6 weeks and 8 months later. The measures of the refractive power of the cornea were taken again. Repeated-measures analysis of variance was used to evaluate the differences between the measures. RESULTS: There were no statistically significant differences in refractive power of the cornea in the topographic maps obtained before the radiotherapy and the two follow-up examinations after the radiotherapy. CONCLUSIONS: Thyroid orbitopathy is an orbital disease and may affect corneal topographic results. Orbital irradiation reduces or eliminates pathogenic orbital lymphocyte infiltration, thereby reducing orbital and extraocular muscle edema in patients with thyroid orbitopathy. In the current study group, corneal topographic changes were observed minimally as a result of the orbital irradiation, but they were not statistically significant.

Adult↗

PubMed2006

Orbital morphology in exophthalmos and exorbitism.

BACKGROUND: Exophthalmos is a protrusion of the eyeball due to an increase in orbital contents in a normal bony orbit. Exorbitism is a protrusion of the eyeball due to a decrease in capacity of the orbital container, with a normal orbital content volume such as seen in a congenital form termed nonsyndromic exorbitism. High myopia can enhance proptosis. The purpose of this study was to provide values for orbital measurements from computed tomography and to suggest computed tomography criteria for nonsyndromic exorbitism. METHODS: Seventy-three computed tomography scans were collected (57 of Graves' ophthalmopathy and 16 of nonsyndromic exorbitism). Thirty-two scans from nonproptotic patients constituted a control series. Nine measurements and two indexes, performed on a reference axial computed tomography slice transecting the neuro-ocular plane, were obtained from each scan. RESULTS: The angle between the sagittal axis and the lateral orbital wall, as well as the width of the ethmoid bone (midinterorbital distance), was found to be more open in the nonsyndromic exorbitism population. A lateral orbital wall angle greater than or equal to 42 degrees and a midinterorbital distance greater than 30 mm were chosen as cutpoints. The association of these two criteria allowed the authors to obtain a sensitivity of 62 percent, a specificity of 78 percent, a positive predictive value of 80 percent, and a negative predictive value of 86 percent for nonsyndromic exorbitism. CONCLUSIONS: The different mechanisms of globe protrusion have to be taken into account before an orbital expansion/decompression procedure is planned. Only a preoperative morphological analysis of the orbital shape permits a precise analysis of the relative position of the ocular globe and orbital structures, in addition to clinical examination.

Adult↗

PubMed1987

Orbital myositis: a study of six cases.

Orbital myositis implies orbital inflammation confined to one or more of the extraocular muscles. Orbital computerised tomography (CT) demonstrates irregular extraocular muscle enlargement which extends anteriorly to involve the tendon (muscle insertion). Six cases of presumed orbital myositis are reported, in each of whom the diagnosis was suspected clinically and confirmed by the orbital CT scan appearances. The mean age of the patients was 33 years (range 8-45 years). All presented with painful ophthalmoplegia and the majority manifested proptosis (five cases), conjunctival congestion (five cases) and periorbital and eyelid edema (two cases). Systemic corticosteroid therapy was used in two patients initially and also in another patient who relapsed, with rapid and dramatic responses. Extraocular muscle biopsy was performed in one case, disclosing features of non-specific muscle inflammation and no evidence of vasculitis. It is considered that orbital myositis is a discrete, identifiable subgroup within the spectrum of the nonspecific idiopathic orbital inflammatory syndromes; termed previously orbital 'pseudotumours'. Although the clinical features are frequently suggestive, they are nonspecific, and non-invasive investigations such as orbital ultra-sonography and CT scanning are required for precise anatomical tissue localisation and diagnosis. The role of ocular muscle biopsy is probably limited to atypical cases, or those unresponsive to steroid therapy, particularly to exclude neoplasia. Orbital myositis may be acute, subacute or recurrent. The acute form responds well to high doses of oral corticosteroids tapered gradually, but it may recur or become chronic. The subacute form of the disease responds less well.

Adult↗