Idiopathic orbital myositis in a pregnant woman

A case of a 29-year-old woman who presented at 25 weeks’ gestation with acute onset of painful diplopia and periorbital swelling is presented. Following further investigation, a diagnosis of idiopathic acute lateral rectus myositis was established. Her condition resolved following a 4-week course of oral prednisolone without recurrence. A healthy female was delivered at 40 weeks’ gestation. The presenting features, differential diagnosis, treatment and course of orbital myositis are discussed.

CASE REPORT OF IDIOPATHIC BILATERAL ORBITAL MYOSITIS

Orbital myositis is an inflammatory disease affecting extraocular muscles. Mostly unilateral and rarely bilateral orbital involvement is seen. Bilateral involvement is a secondary table to systemic diseases and recurrence can be seen. Diagnosis is made by clinical, examination and imaging. Increased density of extraocular muscles and increased muscle mass should be seen in computed tomography or magnetic resonance imaging. The basis of the diagnosis is exclusion and the differential diagnosis needs to be done well. Steroids and other immunosuppressive agents may be used in the treatment. Patients respond dramatically to steroid treatment. While short-term steroid treatment may be sufficient in idiopathic patients, orbital myositis secondary to systemic disease requires longer-term and non-steroid immunosuppressive treatments. Here, a case of idiopathic orbital myositis with bilateral involvement is presented as it is a rare condition.

Eye pain in 13-year-old teenager: a case report of idiopathic orbital myositis

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Clinical Features of Ocular Motility in Idiopathic Orbital Myositis

Objective: To elucidate the clinical features of ocular motility and the risk factors for recurrence in idiopathic orbital myositis. Methods: The medical records of 31 patients diagnosed with idiopathic orbital inflammation between 2003 and 2019 were retrospectively reviewed. All patients were initially treated with corticosteroids. Treatment outcome and ocular motility were noted. Results: Twenty-six patients (84%) had unilateral involvement and five patients (16%) were bilateral. Of the 31 patients, 22 patients (71%) showed ocular motility limitation. The mean grading scale of extraocular muscle (EOM) limitation was −1.65 ± 1.80. EOM limitation was found in the same direction of the most affected muscle in 14 patients (64%), while 8 patients (36%) showed duction limitation in the opposite direction. Nine patients (35%) suffered from recurrence. Recurrence was more likely to occur in patients with multiple muscle involvement (p < 0.001). The interval to relapse of symptoms after discontinuation of steroids was significantly shorter in patients with multiple recurrences compared to those with a single recurrence (1.8 ± 0.8 weeks versus 6.0 ± 1.4 weeks, p = 0.020). Conclusions: Idiopathic orbital myositis showed variable degrees of ocular motility limitation, and limitation in the same direction of the action of the affected muscle was more frequent. Recurrent myositis was more likely to have multiple muscle involvement. Rapid relapse of symptoms after discontinuation of steroids was a significant indicator of multiple recurrences.