Skip to content
BY-NC-ND 3.0 license Open Access Published by De Gruyter Open Access December 6, 2013

Cutting the edge of idiopathic recurrent orbital myositis

  • Alessandra Ariatti EMAIL logo , Giuliana Galassi , Raffaella Rovati and Annalisa Chiari
From the journal Open Medicine


The spectrum of orbital inflammatory diseases ranges broadly from specific diseases as connective tissue disorders, thyroid ophthalmopathy to non-specific inflammations, which may involve one or multiple structures of the orbit and/ or the surrounding sinus. Idiopathic orbital myositis (IOM) may be a localized process or it can be secondary to systemic diseases. We report 4 patients affected by IOM; in all relapsing diplopia was the main complaint, associated with orbital pain in 3 and with abnormal visual evoked responses in 2. Computed tomography (CT), magnetic resonance imaging (MRI) supported the diagnosis revealing enlargement, altered signal intensity of affected muscles. Repeated MRI scans and extensive laboratory examinations comprising of the search for a remote malignacy, lymproliferative, connective tissue diseases, thyroid ophthalmopathy were necessary to confirm the diagnosis. Oral or/and intravenous steroids were main treatments; relapses often occurred when steroid was tapered down. Intravenous immuneglobulins and azathioprine was used in one refractory case

[1] Siatkowski RM, Capo H, Bryne SF, Gendron EK, Flynn JT, Muñoz M, Feurer WJ Clinical and echographic findings in idiopathic orbital myositis. Am J Ophthalmol 1994;118: 343–350 10.1016/S0002-9394(14)72959-9Search in Google Scholar

[2] Attarian S, Fernandez C, Azulay J-Ph, Serratrice J, Pellissier J-F, Pouget J. Myosites orbitaire: étude clinique,radiologique et profil évolutif. Rev Neurol (Paris) 2003;159:307–312 Search in Google Scholar

[3] Pagès M, Malanda G, Mayembo MA. Ophthalmoplegie indolore et rècidivante révélatrice d’une myosite orbitaire. Rev Neurol (Paris) 2005; 161: 224–225 in Google Scholar

[4] Pollard ZP. Acute rectus muscle palsy in children as a result of orbital myositis. J Pediat 1996;128:230–3 in Google Scholar

[5] Fischer M, Kempkes U, Haage P, Isenmann S. Recurrent orbital myositis mimicking sixth nerve palsy: diagnosis with MR imaging. AJNR 2010; 31: 275–276 in Google Scholar

[6] Avni-Zauberman N, Tripathy D, Rosen N, Ben Simon GJ. Relapsing migratory idiopathic orbital inflammation: six new cases and review of the literature. Br J Ophthalmol 2012; 96: 276–280 in Google Scholar

[7] Wasmeier C, Pfadenhauer K, Rösler A. Idiopathic inflammatory pseudotumor of the orbit and Tolosa-Hunt syndrome- are they the same disease? J Neurol 2002;249:1237–1241 in Google Scholar

[8] Matsuno K, Osako M, Osako S, Okano T, Kotake F, Usui M. A case of orbital myositis complicated with optic neuropathy-analysis of the pathological mechanism of optic neuropathy from magnetic resonance imaging findings. Nippon Ganka Gakkai Zasshi. 2002; 106: 304–311 10.1016/S0021-5155(02)00586-5Search in Google Scholar

[9] Wallace ZS, Khosroshahi A, Jakobiec FA, Deshpande V, Hatton MP, Ritter J, Ferry JA, Stone JH. IgG4-related systemic disease as a cause of “idiopathic”orbital inflammation, including orbital myositis and trigeminal nerve involvement. Surv Ophthalmol 2012; 57: 26–33 in Google Scholar

[10] Lee MS, Lessell S. Orbital myositis posing as cluster headache. Arch Neurol 2002; 59: 635–636 in Google Scholar

[11] Shambal S, Lindner A, Zierz S. Successful treatment of orbital myositis with intravenous immunoglobulins. Muscle Nerve 1998; 21: 1359–60<1359::AID-MUS26>3.0.CO;2-W10.1002/(SICI)1097-4598(199810)21:10<1359::AID-MUS26>3.0.CO;2-WSearch in Google Scholar

[12] Hatton MP, Rubin PAD, Foster CS. Successful treatment of idiopathic orbital inflammation with mycophenolate mofetil. Am J Ophthalmol 2005; 140: 916–918 in Google Scholar PubMed

Published Online: 2013-12-6
Published in Print: 2013-12-1

© 2013 Versita Warsaw

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Downloaded on 26.9.2023 from
Scroll to top button