Treatment of recalcitrant idiopathic orbital inflammation (chronic orbital myositis) with infliximab

Orbital inflammatory disease: a diagnostic and therapeutic challenge

“…108 Several classes of immunomodulatory agents have been variably useful in OID. 80,[109][110][111][112][113][114][115][116][117][118] Methotrexate acts on rapidly proliferating cells and suppresses both T and B lymphocyte function; however, it is also known to enhance release of adenosine, which has potent antiinflammatory effects. It has a long history of successful use as a steroid-sparing therapy or as an adjunct to steroids in patients of all age groups who have rheumatoid arthritis or uveitis syndromes.…”

“…A recent report of seven patients with recalcitrant orbital myositis, previously treated with steroids and either radiotherapy or other anti-inflammatory medications, documented clinical response in all patients to infliximab therapy. 112 Underlying disease associations in these patients included Crohn's disease (n ¼ 2), Behcet's disease (n ¼ 1), and psoriasis (n ¼ 1) and the mean follow-up for response was 15.7 months, with a range of 4-31 months. Other case reports have documented therapeutic responses in Churg-Strauss syndrome and myositis.…”

Orbital inflammatory disease management

“…A population-based study has shown that ocular involvement occurs in 1-2% of patients with IBD [167], with the prevalence of orbital manifestations being presumably lower. Less than 25 cases of IBD associated with orbital inflammation and/or orbital myositis have been reported in the literature [9,[168][169][170][171][172][173][174][175][176][177][178][179][180][181][182][183][184][185].…”

Non-infectious orbital vasculitides

“…All three describe inflammation of extraocular muscles and in one case the patient had dacryoadenitis as well. [75][76][77] None of these patients had orbital biopsies performed. Given the paucity of data describing BD and orbital involvement and the lack of orbital biopsies, it is difficult to determine if the orbital inflammation was truly secondary to BD.…”

“…CT and MRI scans demonstrated enhancement and enlargement of extraocular muscles and the lacrimal gland. [75][76][77] Diagnosis at this time is made on the association of symptoms, signs, and laboratory studies consistent with BD and the development of orbital inflammation. There have been several studies indicating decreased blood flow in the ophthalmic artery in BD, though it is uncertain if this is related to orbital involvement.…”