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Indian Journal of Ophthalmology Oct 2021To study the clinical presentation, radiological features, diagnosis, and treatment response in subconjunctival and atypical orbital myocysticercosis.
PURPOSE
To study the clinical presentation, radiological features, diagnosis, and treatment response in subconjunctival and atypical orbital myocysticercosis.
METHODS
Retrospective analysis of diagnosed subconjunctival and atypical (strabismus, diplopia, and blepharoptosis) orbital myocysticercosis was performed. A diagnostic criterion (2 of the 3) among clinical features, radiological findings, and treatment response was used in our study. A minimum of "post-treatment" follow-up of 12 months was observed.
RESULTS
Thirty-five patients were included with a mean age of 16 years having male predominance (n = 22, 62.8%). All had a unilateral presentation, with 24 (68.6%) patients having subconjunctival cysticercosis, of which 22 were located in close proximity of the rectus muscle insertion. At presentation, 10 patients had diplopia, 7 had strabismus, and 6 had face turn. Pseudo Duane's and pseudo-Brown's syndrome were noted in 5 and 4 patients, respectively. Radiologically, single muscle myositis without scolex was seen in 12 (34.3%) cases. All patients first received medical treatment, and surgical intervention (cyst removal) was attempted after treatment failure. Complete resolution of symptoms was noted in 22 (after medical treatment only) and in 8 (after surgery).
CONCLUSION
In the majority, the subconjunctival cysticercosis is found in proximity to the rectus muscle insertion, as a part of orbital myocysticercosis. In atypical scenarios, a satisfactory response to medical treatment can be considered as diagnostic of cysticercosis.
Topics: Adolescent; Cysticercosis; Eye Infections, Parasitic; Humans; Male; Oculomotor Muscles; Orbital Diseases; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34571635
DOI: 10.4103/ijo.IJO_568_21 -
Oman Medical Journal Mar 2018Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized immune-mediated condition comprised of a collection of disorders that share specific... (Review)
Review
Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized immune-mediated condition comprised of a collection of disorders that share specific pathological, serological, and clinical features. IgG4-RD is a fibroinflammatory condition with a tendency to form tumors with inflammatory infiltrate with IgG4 rich plasma cells and elevation of serum IgG4, which may affect virtually every organ and tissue. IgG4-related ophthalmic disease may present as dacryoadenitis, myositis, or involvement of other orbital tissue. Hypophysitis or pachymeningitis may manifest as cranial neuropathies. The diagnosis of IgG4-RD is based on a typical clinical scenario, supportive laboratory test, expected radiological characteristics, and distinct histopathological and immunohistochemical features. Corticosteroids and immunosuppressives form the mainline treatment.
PubMed: 29657677
DOI: 10.5001/omj.2018.20 -
World Journal of Radiology Apr 2014Orbital inflammatory disease (OID) represents a collection of inflammatory conditions affecting the orbit. OID is a diagnosis of exclusion, with the differential... (Review)
Review
Orbital inflammatory disease (OID) represents a collection of inflammatory conditions affecting the orbit. OID is a diagnosis of exclusion, with the differential diagnosis including infection, systemic inflammatory conditions, and neoplasms, among other conditions. Inflammatory conditions in OID include dacryoadenitis, myositis, cellulitis, optic perineuritis, periscleritis, orbital apicitis, and a focal mass. Sclerosing orbital inflammation is a rare condition with a chronic, indolent course involving dense fibrosis and lymphocytic infiltrate. Previously thought to be along the spectrum of OID, it is now considered a distinct pathologic entity. Imaging plays an important role in elucidating any underlying etiology behind orbital inflammation and is critical for ruling out other conditions prior to a definitive diagnosis of OID. In this review, we will explore the common sites of involvement by OID and discuss differential diagnosis by site and key imaging findings for each condition.
PubMed: 24778772
DOI: 10.4329/wjr.v6.i4.106 -
European Journal of Rheumatology Jul 2021
PubMed: 34059187
DOI: 10.5152/eurjrheum.2021.20186 -
Acta Medica Portuguesa 1997Orbital myositis is a subgroup of the nonspecific inflammatory syndrome or orbital pseudotumor and is characterized by a primary inflammation of extraocular muscles. The... (Review)
Review
Orbital myositis is a subgroup of the nonspecific inflammatory syndrome or orbital pseudotumor and is characterized by a primary inflammation of extraocular muscles. The authors describe a 70-year-old patient with acute proptosis, ocular pain and right ophthalmoplegia, whose orbital computed tomographic scan showed enlargement of the homolateral extraocular muscles. Clinical presentation and complementary tests were compatible with the diagnosis of orbital myositis however, because of the particular aspects, which included retinal central vein occlusion, optic nerve lesion, distension of the superior ophthalmic vein and the homolateral cavernous sinus, the differential diagnosis with cavernous sinus pathology and thyroid ophthalmopathy was considered. The importance of a rapid diagnosis and treatment is stressed.
Topics: Aged; Female; Glucocorticoids; Humans; Neurologic Examination; Orbit; Orbital Pseudotumor; Prednisolone; Tomography, X-Ray Computed
PubMed: 9446484
DOI: No ID Found -
Journal of Ayub Medical College,... 2020The orbital myositis is a rare inflammatory disorder of extraocular muscles and is considered a subtype of nonspecific orbital inflammatory syndrome. It is usually a...
The orbital myositis is a rare inflammatory disorder of extraocular muscles and is considered a subtype of nonspecific orbital inflammatory syndrome. It is usually a unilateral disease process with a limited course. We report a case of a 34-year-old man who was referred to the Radiology Department at Shifa International Hospital, Islamabad with 6 months history of severe pain, swelling, and redness in the left eye associated with blurring of vision and headache. Initially, the patient had contrast enhanced CT scan orbits which showed asymmetrically thickened, minimally enhancing left optic nerve having indistinct margins with thickened superior rectus and superior oblique muscles, indistinct superior ophthalmic vein, soft tissue nodularity in the medial intraconal space fat, and slight left exophthalmos. Differentials of orbital pseudo tumour and lymphoma were given. Further evaluation by post contrast MRI with orbits protocol was suggested which showed proptosis, the significant infiltrative disease in the superomedial aspect of left orbit involving the adjacent fat with thickening, enlargement, and heterogeneous enhancement of the superior rectus, medial rectus, and superior oblique muscles with relatively lesser degree involvement of their tendons. The infiltrative thickening also involved the optic nerve sheath and seen invading the optic nerve at the orbital apex. On basis of the imaging features and clinical picture, a diagnosis of orbital myositis with optic neuropathy was given. The patient was given corticosteroids and showed rapid symptomatic improvement.
Topics: Adult; Humans; Male; Oculomotor Muscles; Orbital Myositis
PubMed: 33754537
DOI: No ID Found -
European Journal of Ophthalmology Sep 2023To report three cases of ocular myositis and scleritis, bilateral scleritis and unilateral single muscle myositis after mRNA COVID-19 vaccination.
PURPOSE
To report three cases of ocular myositis and scleritis, bilateral scleritis and unilateral single muscle myositis after mRNA COVID-19 vaccination.
METHODS
Case series of three patients who presented to the Orbit Outpatient Service of Fondazione Policlinico Universitario A. Gemelli with a history of unilateral proptosis, diplopia and pain, bilateral red eye and pain during eye movements and unilateral proptosis and inconstant diplopia respectively with onset 5-10 days after m-RNA COVID-19 vaccine. A thorough hematologic work up and orbital contrast enhanced magnetic resonance imaging (MRI) in patients with proptosis was performed.
RESULTS
Patients were females, 64, 58 and 45 years old respectively. MRI showed enlargement of all right rectus muscles, with both muscle belly and insertion involvement in the first case associated to right scleritis. A bilateral scleritis was diagnosed in the second patient and a single muscle myositis in the third patient. Serological tests excluded thyroid diseases. The first and second patient were treated respectively with oral and topical glucorticoids with a complete clinical response. Two 2 cycles of oral non-steroidal anti-inflammatory drugs were administered to the third patient with a partial response.
CONCLUSION
As far as we know these are the first report of orbital myositis and scleritis presenting after mRNA BNT162b2 vaccine (Pfizer/BioNTech) and mRNA-1273-(Moderna) vaccine, an uncommon effect of a likely autoimmune reaction triggered by the virus antigen.
Topics: Female; Humans; Male; BNT162 Vaccine; COVID-19; COVID-19 Vaccines; Diplopia; Exophthalmos; Myositis; Orbital Myositis; Pain; Scleritis
PubMed: 36062603
DOI: 10.1177/11206721221123780 -
American Journal of Ophthalmology Case... Sep 2022We report the case of a 32-year-old woman with orbital myositis prior to onset of Behcet's disease (BD).
PURPOSE
We report the case of a 32-year-old woman with orbital myositis prior to onset of Behcet's disease (BD).
OBSERVATIONS
A 32-year-old woman was referred to our hospital for a complaint of right eyelid swelling, eye pain, and diplopia. Her best-corrected visual acuity was 20/32 on the right, and 20/16 on the left. She was diagnosed as idiopathic orbital inflammation, and received two pulses of intravenous administration of methylprednisolone, followed by oral prednisolone. Three months later, she developed bilateral orbital myositis, and received one more pulse therapy, followed by oral prednisolone and cyclosporin. About one year after the first visit, oral aphthae, genital ulcers, and folliculitis-like skin rash appeared, and the physician diagnosed incomplete type BD. The patient had no uveitis during the disease course. Orbital inflammation and systemic manifestations of BD were ultimately well controlled with small doses of prednisolone.
CONCLUSION AND IMPORTANCE
BD may develop during the course of orbital inflammation.
PubMed: 35845748
DOI: 10.1016/j.ajoc.2022.101630 -
Case Reports in Ophthalmological... 2015Purpose. To report a case of orbital myositis associated with Coxsackie virus and its medical and surgical approach. Methods. Complete ophthalmological examination and...
Purpose. To report a case of orbital myositis associated with Coxsackie virus and its medical and surgical approach. Methods. Complete ophthalmological examination and imaging and analytical investigation were performed. Results. A 6-year-old male presented with subacute painless binocular horizontal diplopia. Examination revealed bilateral best-corrected visual acuity (BCVA) of 20/20 and right eye 45-prism-dioptre (PD) esotropia in near and distance fixations, with no motility restrictions. Serologic screening was positive for Coxsackie virus acute infection and computerized tomography (CT) suggested right eye medial rectus orbital myositis. An oral corticosteroid 1.0 mg/kg/day regimen was started. A new CT after two months showed symmetrical lesions in both medial rectus muscles. Corticosteroids were increased to 1.5 mg/kg/day. After imagiological resolution on the 4th month, alternating 45 PD esotropia persisted. Bilateral 7 mm medial rectus recession was performed after 1 year without spontaneous recovery. At 1-year follow-up, the patient is orthophoric with 200'' stereopsis and bilateral 20/20 BCVA. Conclusions. To our knowledge, this is the first reported case of orbital myositis associated with Coxsackie virus. This is also the first reported case of isolated strabismus surgery after orbital myositis in pediatric age, highlighting the favourable aesthetic and functional outcomes even in cases of late ocular motility disorders.
PubMed: 26550508
DOI: 10.1155/2015/917275 -
Journal of AAPOS : the Official... Apr 2021Orbital myositis is a rare, commonly idiopathic, inflammatory condition that affects one or more extraocular muscles. We present a case of unilateral orbital myositis...
Orbital myositis is a rare, commonly idiopathic, inflammatory condition that affects one or more extraocular muscles. We present a case of unilateral orbital myositis affecting the lateral rectus muscle presenting with gaze-evoked amaurosis, pain, and diplopia, with restrictive limitation of adduction. With improvement in adduction after initiating treatment, we noted narrowing of the palpebral fissure on attempted adduction, mimicking Duane retraction syndrome (DRS). Reported cases of "pseudo-DRS" are associated with multiple etiologies and are characterized by retraction on attempted abduction rather than adduction, as occurs in true DRS. In this case, pseudo-DRS occurred in the setting of idiopathic orbital inflammatory syndrome (orbital myositis) with a motility pattern more consistent with true DRS.
Topics: Diplopia; Duane Retraction Syndrome; Eyelids; Humans; Oculomotor Muscles; Orbital Myositis
PubMed: 33652102
DOI: 10.1016/j.jaapos.2020.11.012