Orbital Inflammatory Disease
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:
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To elicit features on history and examination that may help distinguish the underlying cause for the patient’s presentation, and
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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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2021, Progress in Retinal and Eye ResearchCitation Excerpt :Bony or mucosal sinus involvement are rare in NSOI, and other diseases such as GPA, IgG4-ROD, or malignancy should be primarily considered (Mombaerts et al., 2017). Continuous extension from ethmoidal air cells and subperiosteal abscess formation can be seen in orbital cellulitis (Jacobs and Galetta, 2002; Lutt et al., 2008). The MRI signal intensity of inflammatory lesions is hypo- or isointense on T1-weighted image (T1-WI).
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2018, Advances in Ophthalmology and OptometryCitation Excerpt :NSOI has a wide spectrum of clinical features, anatomic involvement, disease course, and response to therapy. Because of this tremendous clinical variability, NSOI may be confused with other orbital diseases, including infectious orbital cellulitis, thyroid-associated orbitopathy, malignancy, and numerous other immunologic and vasculitic processes [2]. NSOI remains a diagnosis of exclusion, and all other specific causes must be ruled out [3].
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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JTR receives grant support from Genentech and Centocor, owns stock in Amgen, and has consulted for Centocor and Abbott.