This retrospective study reviewed the demographic characteristics of patients with orbital myositis, their clinical profile, management options, outcomes and predictive factors for recurrence. The study included 52 patients (55 eyes; 3% bilateral involvement), 36 females, with mean age at presentation of 36 ±16 years (four aged under 16). Acute presentation occurred in 14 and sub-scute / chronic in 38. Primary presentation was to oculoplastic clinics in 30, strabismus clinic in 11, emergency room in three, corneal clinic in five, glaucoma clinic in one and uvea clinic in one. Follow-up was from 4–480 weeks (median 24 weeks). Duration of symptoms prior to presentation was 0.27–144 weeks (median eight weeks). The most frequency symptoms were periocular pain in 30 and diplopia in 27 cases. Best corrected visual acuity was 0.08 ±0.07logMAR. Twelve cases had impaired colour vision, six had pupil abnormalities, 33 had strabismus, and five had abnormal head posture. For ocular motility findings, 40 had limited abduction, 30 limited elevation, 22 limited adduction and 17 limited depression. Orbital imaging showed extraocular muscle thickening; 34 with tendon involvement. Multiple extraocular muscle involvement was found in 33 cases and nine had associated lacrimal gland involvement. Of all cases, 25 had muscle biopsy. Treatment options included mainly steroids. For longer term management, there was a switch to steroid-sparing immune-modulators. Three cases required strabismus surgery. Recurrence was noted in 16 eyes at a median of two months from initial presentation. The only significant risk factor was abrupt cessation of steroids. At final follow-up, 91% showed recovery.
Profile of presentation, follow-up and management of orbital myositis
Reviewed by Fiona Rowe
Orbital myositis and strabismus: clinical profile, management and predictive factors.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
View Full Profile
