Orbital Inflammatory Disease

https://doi.org/10.1016/j.semarthrit.2007.06.003Get rights and content

Objectives

To familiarize rheumatologists and internists with the signs, symptoms, and management of orbital inflammatory disease (OID).

Methods

A comprehensive literature review related to OID was performed and reported from the perspectives of rheumatology, ophthalmology, and radiology.

Results

OID is a general term encompassing inflammatory diseases that affect some or all of the structures contained within the orbit external to the globe. Orbital involvement as a part of the initial symptom complex is not uncommon for systemic diseases such as Graves’ disease, Wegener’s granulomatosis, and sarcoidosis. The management of these and other causes of OID, such as idiopathic orbital inflammation (formerly known as “orbital pseudotumor”), orbital myositis, and Tolosa–Hunt syndrome frequently involves systemic immunosuppression. Before immunosuppression is considered, however, infectious and malignant causes of inflammation must be ruled out.

Discussion

Rheumatologists should be familiar with the differential diagnosis of OID and often need to assist colleagues in ophthalmology and internal medicine with the management of this group of diseases.

Section snippets

Methods

A comprehensive literature review regarding OID was performed and reported from the perspectives of rheumatology, ophthalmology, and radiology.

Clinical Assessment of Orbital Inflammatory Disease

The aims of the clinical assessment of a patient with OID are as follows:

  • 1

    To elicit features on history and examination that may help distinguish the underlying cause for the patient’s presentation, and

  • 2

    To identify patients with rapidly progressive, advanced disease who are at the greatest risk of visual loss.

History

Typical symptoms of OID include binocular diplopia (ie, double vision with both eyes open that resolves with the closure of either eye), a “bug-eyed” appearance (Fig. 1), ocular injection,

Discussion

Although OID is not a common diagnosis in a rheumatology practice, orbital disease occurs classically in WG. Rheumatologists should be familiar with the signs, symptoms, and differential diagnosis of OID; recognize the role for imaging, biopsy, and surgical treatment; and assist ophthalmologists or other specialists in managing selected patients with conditions such as TAO and IOI with immunosuppression.

Acknowledgments

We acknowledge the assistance of the Medical Photography Departments of the Casey Eye Institute, Portland, Oregon and the Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia. We are grateful to Deb Carter for help with the illustrations. The Stan and Madelle Rosenfeld Family Trust and Research to Prevent Blindness provided financial support.

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    JTR is a Senior Scholar supported by Research to Prevent Blindness (RPB), New York City. LLL is a Senior Research Fellow and is supported by the Crock and Ann-Marie Mankiewicz-Zelkin Trusts. This research was supported by unrestricted funds from RPB and a gift from the Stan and Madelle Rosenfeld Family Trust.

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