Inflammation of the orbit

Idiopathic inflammation of the orbit (formerly known as the pseudotumor of the orbit) is a rare pathology that is non-tumor, noninfectious, orbital lesion of the orbit. The inflammatory process can include any or all of the soft tissues in orbit at once.

Histopathologically it is polymorphic-cellular inflammatory infiltration, which passes into reactive fibrosis. The course of the process is not determined by its clinical and pathological characteristics. In adults, the disease is one-sided; in children it can be bilateral. Simultaneous damage to the orbit and sinuses of the nose is rare.

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Symptoms of orbital inflammation

It appears in 3-6 decades of life with acute redness, swelling and pain, usually on the one hand.

Symptoms

• Stagnant exophthalmos and ophthalmoplegia.
• Violation of the functions of the optic nerve in the spread of inflammation to the posterior parts of the orbit.

The flow has several options:

• Spontaneous remission after a few weeks without consequences.
• Continuous intermittent course without complete remission with episodes of exacerbation.
• A severe prolonged course leading to progressive fibrosis of orbital tissues and eventually to a "frozen" orbit characterized by ophthalmoplegia is possible with ptosis and visual impairment due to the involvement of the optic nerve in the process.

Acute dacryoadenitis

Lesion of the lacrimal gland occurs about 25% of cases of idiopathic inflammation of the orbit. However, more often dacryoadenitis is isolated and spontaneously docked without requiring treatment.

Clinical Features

It shows acute discomfort in the area of the lacrimal gland.

Symptoms

• Edema of the outer part of the upper eyelid leads to the appearance of a characteristic S-shaped ptosis and light dystopia down and inside.
• Soreness in the fossa of the lacrimal gland.
• Injection of palpebral lacrimal gland and adjacent conjunctiva.
• There may be a decrease in tear production.

Differential diagnostics

1. Inflammation of the lacrimal gland is observed in epidemic parotitis, mononucleosis and less often - bacterial infection.
2. The rupture of the dermoid cyst can lead to inflammation in the area of the lacrimal gland.
3. Malignant tumors of the lacrimal gland can cause pain, but the onset is usually not acute.

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Tolosa Syndrome - Hunt

A rare condition, which is a granulomatous inflammation of the cavernous sinus, the upper orbital gap, and / or the apex of the orbit. The clinical course is characterized by remissions and exacerbations.

It is manifested by a diplopia accompanied by pain in the ipsilateral orbit or in half of the head corresponding to painful localization.

Symptoms

• Exophthalmos, if present, are not expressed.
• Paralysis of the oculomotor nerve, often with internal ophthalmoplegia.
• Disturbance of sensitivity along the first and second branches of the trigeminal nerve.

Treatment: systemic steroid therapy.

Granulomatosis Wegener

Granulomatosis Wegener usually affects both orbits, spreading from the adjacent sinuses of the nose or from the nasopharynx. Primarily the orbit suffers less often. Granulomatosis Wegener must be considered in all cases of bilateral inflammation of the orbits, especially when combined with sinus involvement. The detection of antineutrophil cytoplasmic antibodies is a very useful serological test.

Symptoms

• Exophthalmos, signs of orbital congestion and ophthalmoplegia (often bilateral).
• Dacryoadenitis and occlusion of the nasolacrimal canal.
• It is combined with scleritis and marginal ulcerative keratitis.

Treatment

• Systemic use of cyclophosphamide and steroids is highly effective. In stable cases, cyclosporine, azathiopril, antithymic globulin or plasmapheresis can be effective.
• In severe orbital damage, there may be a need for surgical decompression of the orbit.

Treatment of orbital inflammation

1. Observation with relatively easy flow in the hope of spontaneous remission.
2. A biopsy may be required in persisting cases to confirm the diagnosis and exclude the tumor.
3. Systemic administration of steroids is effective in 50-75% of patients in medium and severe cases. The initial doses of prednisolone are 60-80 mg per day, with a gradual decrease to complete cancellation, depending on the efficacy and possible reappointment for relapse.
4. Radiotherapy can be prescribed if inadequate steroid therapy is ineffective within 2 weeks. Even irradiation with small doses (for example, 10 Gy) can lead to a prolonged, and sometimes permanent remission.
5. Cytotoxic drugs. Such as cyclophosphamide at 200 mg per day, are used when steroid and radiation therapy is ineffective.

Differential diagnostics

1. Bacterial cellulitis of the orbit should be considered with a strong reddening of the tissues of the anterior part of the orbit. Trial system antibiotic therapy may be required to establish a correct diagnosis.
2. Expressed acute manifestations of endocrine ophthalmopathy may be similar to idiopathic inflammation of the orbit, but endocrine ophthalmic disease, as a rule, is bilateral, whereas idiopathic inflammation of the orbit is usually one-sided.
3. Systemic diseases such as Wegener granulomatosis, nodular periarteritis, Waldenstrom macroglobulinemia, may be accompanied by orbital symptoms similar to idiopathic orbital inflammation.
4. Malignant tumors of the orbit, especially metastatic.
5. The rupture of the dermoid cyst can lead to secondary granulomatous inflammation with pain syndrome.