Ocular Myositis

Abstract

Ocular myositis frequently manifests with orbital pain and diplopia. The diagnosis of ocular myositis falls within the overall classification of idiopathic orbital inflammatory diseases, defined as non-infective non-specific orbital inflammation without identifiable local or systemic causes. Orbital myositis may form part of more widespread systemic inflammatory processes such as Crohn's disease and the more recently described IgG4-related disease. There is also a broad range of ophthalmic differential diagnoses. Diagnosis, assessment and management of ocular myositis requires the cooperation of ophthalmologists and rheumatologists/immunologists in order to achieve the best patient outcomes. The current literature and avenues of future research are reviewed.

Painful ophthalmoplaegia secondary to orbital myositis

“…The aetiology is unknown but recent research suggests an association with IgG4 2. Differential diagnoses include orbital cellulitis, orbital neoplasm, carotid–cavernous fistulae, arteriovenous malformations and thyroid eye disease 3. Since it can mimic orbital cellulitis, intravenous antibiotics are often started empirically; the lack of response may raise the suspicion of an alternative diagnosis.…”

“…CT/MRI is very useful to aid diagnosis 3. Treatment with high-dose corticosteroids usually produces a dramatic response 3.…”

“…Treatment with high-dose corticosteroids usually produces a dramatic response 3. It can recur and refractory cases may require treatment with immunosuppressant drugs or radiotherapy 3…”

Decreased CD3-CD16+CD56+ natural killer cell counts in children with orbital myositis: a clue to disease activity

“…[1][2][3] OM falls into the category of 'idiopathic orbital inflammation', formerly orbital pseudotumour, 1 and is one of the juvenile inflammatory myopathies. 4 OM can be idiopathic, but has been reported in systemic diseases, including sarcoidosis, Graves' disease, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and IgG4-related disease, and may occur following infection.…”

Orbital myositis secondary to statin therapy

“…Orbital myositis is inflammation of one or more extraocular muscles, characteristically presenting with diplopia and orbital pain exacerbated by eye movement. Restriction of eye movement, exophthalmos, conjunctival inflammation and erythema may occur; 1 imaging indicates muscle and tendon enlargement. It is usually idiopathic, but can occur in association with a range of inflammatory conditions, including sarcoidosis, systemic lupus erythematosus, Crohn's disease and anti‐neutrophil cytoplasmic antibody (ANCA)‐associated vasculitis 1 …”