Summary about Disease
Orbital myositis is an inflammatory condition affecting one or more of the extraocular muscles (muscles that control eye movement) within the orbit (eye socket). It's characterized by inflammation and swelling of these muscles, leading to pain, restricted eye movement, and visual disturbances. Orbital myositis is relatively rare and can be either idiopathic (cause unknown) or associated with systemic inflammatory or autoimmune diseases.
Symptoms
Eye pain, often exacerbated by eye movement
Double vision (diplopia)
Swelling and redness of the eyelids
Proptosis (bulging of the eye)
Restricted eye movement
Headache
Decreased visual acuity (less common)
Causes
Idiopathic: In many cases, the cause is unknown (idiopathic).
Autoimmune diseases: May be associated with systemic autoimmune conditions such as:
Granulomatosis with polyangiitis (formerly Wegener's granulomatosis)
Systemic lupus erythematosus (SLE)
Rheumatoid arthritis
Inflammatory bowel disease
Infections: Rarely, infections can trigger orbital myositis.
Thyroid eye disease: Although technically distinct, thyroid eye disease can cause orbital muscle inflammation.
Medicine Used
Corticosteroids: Prednisone is the most common initial treatment to reduce inflammation. Dosage is typically high initially and then tapered gradually.
Immunosuppressants: In more severe or recurrent cases, other immunosuppressants may be used, such as methotrexate, azathioprine, or mycophenolate mofetil.
Nonsteroidal anti-inflammatory drugs (NSAIDs): May be used for pain relief, but are generally not sufficient to treat the underlying inflammation.
Biologic agents: In refractory cases, medications such as TNF inhibitors, or other biologics may be considered.
Is Communicable
No, orbital myositis is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Follow medical advice: Adhere strictly to the prescribed treatment plan, including medication dosages and follow-up appointments.
Monitor for side effects: Be aware of potential side effects of medications, especially corticosteroids and immunosuppressants, and report any concerns to your doctor.
Protect your eyes: If proptosis is present, use lubricating eye drops to prevent corneal dryness. In severe cases, patching may be needed.
Manage underlying conditions: If the orbital myositis is associated with an autoimmune disease, ensure that the underlying condition is well-controlled.
How long does an outbreak last?
The duration of an orbital myositis outbreak can vary significantly depending on the severity of the inflammation, the underlying cause, and the response to treatment.
Acute cases: With prompt and effective treatment, symptoms may improve within a few days to weeks.
Chronic or recurrent cases: Some individuals may experience chronic or relapsing orbital myositis, requiring longer-term management with immunosuppressants. In these cases, symptoms may persist for months or even years.
How is it diagnosed?
Clinical examination: A thorough eye examination by an ophthalmologist or neuro-ophthalmologist is crucial.
Neuroimaging:
MRI (magnetic resonance imaging) of the orbits: This is the most important imaging modality. It shows enlargement and inflammation of the extraocular muscles.
CT scan (computed tomography) of the orbits: Can also be used, but MRI provides better soft tissue detail.
Blood tests: To look for underlying systemic inflammatory or autoimmune conditions. These may include:
Complete blood count (CBC)
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
Antinuclear antibody (ANA)
Rheumatoid factor (RF)
Anti-neutrophil cytoplasmic antibodies (ANCA)
Thyroid function tests
Biopsy: In rare cases, a muscle biopsy may be performed to confirm the diagnosis and rule out other conditions.
Timeline of Symptoms
The onset of symptoms can be acute (sudden) or subacute (gradual).
Acute onset: Symptoms may develop rapidly over a few days.
Subacute onset: Symptoms may develop more gradually over several weeks. The typical progression involves: 1. Initial symptoms: Eye pain, often worse with eye movement. 2. Progression: Development of double vision, eyelid swelling, and proptosis. 3. Potential complications: In severe or untreated cases, optic nerve compression and vision loss can occur.
Important Considerations
Differential diagnosis: It's crucial to differentiate orbital myositis from other conditions that can cause similar symptoms, such as thyroid eye disease, orbital cellulitis, and orbital tumors.
Underlying conditions: Evaluate for underlying systemic diseases.
Prompt treatment: Early diagnosis and treatment are essential to prevent complications and minimize long-term damage.
Monitoring: Regular follow-up appointments with an ophthalmologist are necessary to monitor the response to treatment and adjust medications as needed.
Refractory cases: Cases that do not respond to initial treatment may require more aggressive immunosuppression or surgical intervention.