[Orbital involvement in Wegener's granulomatosis].

BACKGROUND

Granulomas of the orbit can complicate Wegener's granulomatosis (WG). If they compress the optic nerve, blindness of one or both eyes may result. Therefore, early detection and sufficient treatment are important.

MATERIAL AND METHODS

Computed tomography (CT) and magnetic resonance imaging (MRI) of the orbit and CNS were performed in patients suffering from WG and orbital granulomas (n = 6). The patients were seen interdisciplinary by internists, ENT-specialists, radiologists and ophthalmologists.

RESULTS

12 out of 121 biopsy proven WG-patients showed orbital granulomas during their disease process. Granulomas of the orbit could be best visualized by MRI. However, MRI and CT taken together were most informative. 6 patients with orbital granulomas are presented as case reports, in four of them WG lead to blindness of one eye. The course of orbital granulomas may be chronic progressive or acutely fulminant. Therapy of first choice is a high dosage, long-term immunosuppression with cyclophosphamide and prednisolone.

CONCLUSIONS

The detection of orbital granulomas in WG is most successful using CT and MRI. In addition to that, the analysis of visual acuity and visual field are the most important parameters in the detection and follow-up of orbital granulomas. A high dosage, long-term immunosuppression is the treatment of first choice, but in rapidly progressive cases an early decompression of the orbit has to be discussed additionally.