Intraorbital Injection of Triamcinolone Acetonide in Patients With Idiopathic Orbital Inflammation

Abstract

Objective: To present findings of a pilot study on intraorbital corticosteroid therapy in the management of idiopathic orbital inflammation. Methods: This prospective, noncomparative, interventional case series included patients with clinically, radiologically, and histologically confirmed idiopathic orbital inflammation with an anterior orbital mass. Twenty to 40 mg/mL of triamcinolone acetonide was injected intraorbitally (intralesionally or perilesionally) in all patients. The injection was repeated at 4-week intervals if complete resolution was not achieved. Patients were assessed for local and systemic complications of corticosteroid injection. Visual acuity, fundus examination, in-traocular pressure, blood pressure, and serum glucose levels were measured at each visit. Results: Ten patients (5 men and 5 women; mean age, 49.8 years [age range, 25-82 years]) received treatment. In 4 patients, an orbital mass was noted; in 6 patients, the lacrimal gland was involved (dacryoadenitis). Substantial improvement (1 patient) or complete resolution (8 patients) was noted during a follow-up of 9.8 months (range, 3-24 months). Conclusion: Intraorbital injection of a corticosteroid is an effective treatment for idiopathic orbital inflammation and may be considered first-line treatment in selected patients.

Intraorbital corticosteroid injection for orbital reactive lymphoid hyperplasia

“…Periocular steroids are an established treatment option for many ophthalmic conditions, including uveitis, idiopathic orbital inflammation (IOI), orbital capillary hemangiomas, chalazia, thyroidassociated orbitopathy, saroidosis, vernal keratoconjunctivitis, and orbital xanthogranuloma. 3,4 Although the use of intraorbital steroids has been well described for IOI, 4 there are only two reports of intralesional steroids being used in the treatment of conjunctival RLH, and no reports of this technique being used in orbital RLH. Of the two patients with conjunctival RLH, both were diagnosed in their eighth decade of life, received 20 mg of intralesional triamcinolone, and experienced complete lesion regression by 3 months without complication.…”

“…5,6 The most devastating complication of intraorbital corticosteroid injection is retinal artery occlusion caused by embolization of corticosteroid particulates and retrograde arterial flow induced by high injection pressures. 4 Fortunately, this is rare and is primarily associated with injections into capillary hemangiomas. The risk may be minimized by withdrawing the plunger before injecting, using a 27-gauge needle or larger, and monitoring visual acuity during and after the procedure.…”

“…The risk may be minimized by withdrawing the plunger before injecting, using a 27-gauge needle or larger, and monitoring visual acuity during and after the procedure. 4 Recalcitrant ocular hypertension is a rare but well-described complication that can be avoided by identifying steroid responders before injection. Other possible adverse effects include skin necrosis, atrophy of subcutaneous fat, scleral necrosis, adrenal suppression (one case), and cataract.…”

“…Other possible adverse effects include skin necrosis, atrophy of subcutaneous fat, scleral necrosis, adrenal suppression (one case), and cataract. 3,4 Summary What was known before K There are only two reports of intralesional steroids being used in the treatment of conjunctival RLH, and no reports of this technique being used in orbital RLH.…”

Orbital inflammatory disease management

“…All patients experienced a good response within 1 week and no recurrences were noted (follow-up ranged from 7 to 96 months), although mean follow-up time and response grading criteria were not elucidated. Other studies have also noted favorable results with intralesional corticosteroids [15,18,19].…”