Painful Ophthalmoplegia In a Patient with SLE

Non-infectious orbital vasculitides

“…Patients in the literature have been successfully treated with oral or IV glucocorticoids. [81][82][83][84][85][86][87][88][89][90][91][92][93] Most patients had complete resolution of symptoms after initiating therapy, although there were four cases in which the patients had a recurrence of disease and needed an increase in dosage. [89][90][91] Treatment with steroids was always in addition to their ongoing treatment for SLE or RA.…”

“…In most of these cases, patients had an elevated ANA and ds-DNA along with other systemic symptoms consistent with SLE. [81][82][83][84][85][86][87][88][89][90][91] Arthurs et al 81 described a case of a patient who developed exophthalmos secondary to an orbital mass; biopsy of the mass demonstrated evidence of a pseudotumor with vascular inflammation. This patient eventually developed infarction and subsequent disintegration of orbital structures.…”

“…This patient eventually developed infarction and subsequent disintegration of orbital structures. Other patients developed a myositis with enlargement of the muscles on CT. 83,84,86 Reported cases of orbital inflammation in RA mostly involve patients with limited extraocular movements secondary to a myositis. Nabili et al 92 and Panfilio et al 93 reported cases of extraocular muscle enlargement in patients with a prior history of RA.…”

Orbital inflammatory disease management

“…In most cases, the patient were know to have SLE prior to orbital involvement and hence were undergoing systemic immunosuppressant therapy at the time of orbital presentation. Nonetheless, corticosteroids have been shown to effectively manage orbital and periorbital manifestations of SLE with minimal recurrence [129][130][131][133][134][135][136][138][139][140][141].…”

“…Within the orbit and periorbital region, SLE can have different presentations including panniculitis, diffuse orbital inflammation, eyelid edema, trochleitis, and myositis [129][130][131][132][133][134][135][136][137][138][139][140][141].…”