Orbital myositis

Introduction to orbital myositis Orbital myositis (orbital myositis), also known as extraocular myositis, common symptoms are acute episodes of headache, eye pain and double vision, ptosis, mild edema, slight ocular swelling, conjunctival congestion and edema, pain, rotation limit. basic knowledge The proportion of illness: the incidence rate is about 0.003% - 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: sinusitis

Cause of orbital myositis

Infection factor (25%):

Unilateral eyelid inflammation may be associated with inflammation of the ipsilateral sinus. The causal relationship between the two is still difficult to affirm, but the control of nasal inflammation contributes to the treatment of eyelid inflammation and reduces recurrence. In some patients, there is often upper respiratory tract infection before eyelid inflammation occurs. A medical history, Garner believes that the disease may be related to the autoimmune response caused by virus-induced changes in tissue nuclear proteins. In addition, local infection of inflammatory cells may also be caused by superior oblique muscle surgery, retinal detachment surgery or trauma. disease.

Systemic disease (5%):

It has been found that almost half of patients have a common body disease, such as chronic obstructive pulmonary disease, upper respiratory tract infection, systemic lupus erythematosus, dermatomyositis, rheumatoid arthritis, sarcoidosis, Wegener granulomatosis, etc. Pathogenesis is an immune mechanism.

Immune response (10%):

In patients with this disease, serum IgG and IgM can be increased, IgA levels are often reduced, and a small number of patients are anti-nuclear antibodies and anti-smooth muscle antibodies.

Pathogenesis

1. Infective external myositis refers to extraocular myositis caused by infection with known pathogens.

2. Localized inflammatory extemal myositis refers to inflammation of a certain or adjacent extraocular muscles, such as inflammation limited to the superior oblique muscles and around the trochle known as trochlear osteomyelitis (trochlear Supra oblique myosi-tis), eyelid pain is a stinging aggravation in the trochlear part, the trochlear part and the upper edge of the eyelid are tender, but no ptosis and eyeball protrusion, more common in the superior oblique muscle surgery, retinal detachment surgery or trauma after that.

3. Systemic disease external myositis refers to endogenous myositis caused by systemic immune diseases.

4. Primary orbital inflammatory pseudotumor external myositis is the type of eye muscle of the inflammatory pseudotumor of the sputum. The main features are diplopia, eyelid pain, conjunctival edema, and ptosis. And eyeballs, etc., Yan Jianhua reported that 50% of the extraocular muscles were affected. Among the extraocular muscles, the above rectus muscles were the most common, accounting for 62.5%, the lateral rectus muscle was 43.8%, the medial rectus muscle was 31% and the straight was straight. 31% of the muscle, no upper and lower oblique muscle involvement.

Orbital myositis prevention

Actively treat inflammation of adjacent organs such as conjunctivitis and sinusitis, so as to prevent the spread of inflammation and cause infection of the orbital muscles. Pay attention to the use of the eye reasonably, avoid eye fatigue, avoid staying up late, so as not to cause the resistance to decline.

Orbital myositis complications Complications sinusitis

It can be accompanied by inflammation of the surrounding organs such as the sinuses and viral infections.

Orbital inflammatory symptoms Common symptoms Inflammatory persistent pain Visual impairment Upper ptosis Diplopia Conjunctival hyperemia

Classification

(1) According to the course of the disease can be divided into acute, subacute and chronic:

1 acute extra myositis (acute external myositis), also known as acute orbital myositis (acute orbital myositis), acute onset, often monocular, with ptosis and limited eye movement, eyeballs are prominent, orbital edema, conjunctival congestion , edema, etc., may involve the optic nerve and have visual impairment;

2 chronic external myositis (chronic external myositis), also known as chronic orbital myositis, idiopathic orbital myositis, slow onset, mostly for both eyes, the earliest and most common Symptoms are persistent pain and double vision. When the eyeball rotates, the pain is aggravated. The lesion only affects a single extraocular muscle. It is not selective for each eye muscle. It is equally susceptible, the eye is not common, the conjunctival congestion is light, and the vision is normal. Unaffected, normal vision, no lump around the eyelids, CT and ultrasonography only see extraocular muscle thickening, many scholars regard it as a subtype of orbital inflammatory pseudotumor, which is sensitive to hormones, but Often recurring, recurrence can affect the other eye and its extraocular muscles;

3 subacute external myositis (subacute external myositis), also known as subacute orbital myositis (subacute orbital myositis), the incidence of acute and chronic extraocular myositis, the recurrence rate of this type is high, Weinstein et al reported Seven of the 12 patients were subacute myositis. Those who were treated 2 months or 2 months after the onset of recurrence had recurrence, and 5 of them had more than 2 recurrences.

2. Clinical features

(1) General characteristics: 1 The disease is generally monocular, and both eyes are rare at the same time or in succession, but in severe cases, all eyes of the eye can be simultaneously affected; 2 time of onset; from the beginning of symptoms to the obvious signs of the eye Up to 10 days, the longest is up to several months or years, an average of about 6 weeks, 3 symptoms; acute cases can be expressed as persistent acupuncture-like pain with headache, nausea, vomiting, diplopia And mild visual loss; chronic cases manifested as persistent pain and diplopia in the eyelids, increased pain when the eyeball turns, and decreased visual acuity.

(2) Special signs:

1 eyelid edema and ptosis, conjunctival congestion and edema, mild cases of lesions confined to the site of the inflamed extraocular muscle attachment, severe cases of conjunctival edema uplift, and even prominent cleft palate;

2 eyeballs are prominent in the eye, the eyeball protrusion is usually 1 to 3 mm in light cases, and 5 to 7 mm in severe cases;

3 eyeball rotation is limited, when the eyeball rotates or pushes the eyeball into the sacrum, the pain is intensified, the eyeball is mostly in the outreach position, and when the electromyogram changes to the direction of the affected extraocular muscle, the discharge amount is directly proportional to the eye movement disorder. The detection rate of extraocular muscle invasion is in turn the medial rectus muscle, the lateral rectus muscle and the superior oblique muscle;

4 severe cases may be associated with optic neuritis edema, vascular tortuosity, retinal oozing or bleeding and other ocular lesions.

Examination of orbital myositis

Blood routine examinations have certain value for prompting the condition.

CT or ultrasound examination showed that the affected extraocular muscles included hypertrophy of the tendon and muscle belly.

Diagnosis and differentiation of orbital myositis

According to the typical clinical manifestations of acute extraocular myositis, it is not difficult to diagnose, but many cases have no typical manifestations. They are often misdiagnosed as orbital pseudotumor, total extraocular muscle paralysis, orbital cellulitis, Graves' ophthalmopathy, supracondylar fissure. Syndrome or superficial scleritis.

1. The extraocular extraocular muscle paralysis is acute, the eyeball moves to all directions, the electromyogram shows that the muscle spasm can not be discharged, there is mild eyeball protrusion, no extraocular muscle hypertrophy and thickening changes.

2. Orbital pseudotumor (extraocular muscle type) Some people think that the two are the same disease. When the type A ultrasound is used, the orbital pseudotumor can show that the whole muscle is thickened in the abdominal muscles, sometimes nodular, and the extraocular myositis is The lesions were the heaviest at the point of attachment and the thickest at the point of attachment, while the later muscles were only slightly thickened.

3. Eyelid cellulitis has systemic symptoms such as elevated body temperature, redness and swelling of the eyelids, conjunctival congestion, edema, and prominent eyeballs. The visual acuity can be reduced to no light. After the antibiotic controls inflammation, it can self-heal after the pus.

4. supracondylar syndrome has hypothesis of the first and second branches of the V-brain nerve, impaired eyeballs, progressive ophthalmoplegia, dilated pupils, orbital and conjunctival edema, retinal vein engorgement and retinal edema. .

5. Endocrine extraocular muscle disease often has foreign body sensation, upper eyelid edema, slow onset of diplopia, occasional visual impairment, limited eye movement, CT scan shows thickening of the muscle abdomen, and tendon is not tired.

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