Idiopathic orbital inflammation: distribution, clinical features, and treatment outcome.

Abstract

OBJECTIVE:

To evaluate the distribution and clinical as well as treatment outcome characteristics of idiopathic orbital inflammation with the aim of delineating a more systematic approach to diagnosis and treatment.

METHODS:

A 10-year retrospective review of patients with idiopathic orbital inflammation treated at one institution.

RESULTS:

Ninety eyes in 65 patients (22 men and 43 women) were studied. Diagnoses were isolated dacryoadenitis (n = 21), isolated myositis (n = 19), concurrent dacryoadenitis and myositis (n = 5), orbital apex syndrome (n = 6), and idiopathic inflammation involving the preseptal region, supraorbital region, sclera, Tenon capsule, orbital fat, or optic nerve (n = 14). The mean age at presentation was 45 years. Pain and periorbital swelling were the most common clinical features and were observed in 45 (69%) and 49 (75%) patients, respectively. Seventeen patients (26%) had bilateral involvement. Biopsy was performed in 19 patients (29%) with atypical presentations or who failed to respond to the initial therapy. Patients were treated with steroids alone (n = 45), steroids and subsequent radiation therapy (n = 8), steroids and nonsteroidal anti-inflammatory agents (n = 6), nonsteroidal anti-inflammatory agents alone in mild cases (n = 2), and, rarely, radiation therapy without steroids (n = 1) or surgical debulking alone (n = 1). Of 65 patients, 41 (63%) represented treatment successes, with complete symptom relief at the time of the last follow-up, and 24 (37%) represented treatment failures, with partial or no relief of symptoms. Treatment failures were often characterized by recurrence of inflammation after a period of quiescence (58%) and unremitting, recalcitrant inflammation (38%); 1 patient ultimately required an exenteration.

CONCLUSION:

Systemic steroid with a slow taper has been the established first-line treatment for idiopathic orbital inflammation, but refractory cases accounted for a significant portion of treatment failures in our study, reflecting the need for a more systematic approach to the study of this multifaceted disease and for therapeutic alternatives to systemic steroids.

• Authors: Sonia J Ahn Yuen, Peter A D Rubin
• Journal: Archives of ophthalmology (Chicago, Ill. : 1960) (Arch Ophthalmol) Vol. 121 Issue 4 Pg. 491-9 (Apr 2003) ISSN: 0003-9950 [Print] United States
• PMID: 12695246 (Publication Type: Journal Article)

Chemical References

• Glucocorticoids

Topics

• Adolescent
• Adult
• Age Distribution
• Aged
• Aged, 80 and over
• Biopsy
• Child
• Child, Preschool
• Debridement
• Diagnosis, Differential
• Female
• Glucocorticoids (therapeutic use)
• Humans
• Infant
• Infant, Newborn
• Male
• Middle Aged
• Orbital Pseudotumor (complications, diagnosis, therapy)
• Radiotherapy, Adjuvant
• Retrospective Studies
• Sex Distribution
• Treatment Failure
• Treatment Outcome