Western University of Health Sciences, Pomona, CA, USA.
Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV, USA.
J Investig Med High Impact Case Rep. 2023 Jan-Dec;11:23247096221148261. doi: 10.1177/23247096221148261.
A 65-year-old African American man initially presented to the emergency department complaining of headaches, retro-orbital pressure, decreased vision, white flashes and floaters, and palinopsia of both eyes. After complete evaluation, he was diagnosed with migraine with aura and discharged to home with an ophthalmology follow-up. Upon follow-up with the ophthalmology team, he had developed severe periorbital inflammation, proptosis, chemosis, and vision loss that was greatest on the left side. The patient was immediately hospitalized for further evaluation and steroid treatment. His vision, ocular symptoms, and physical findings dramatically and rapidly improved with a 3-day course of high-dose intravenous steroids. Existing literature is sparse on rapid loss and recovery of vision following steroid treatment for orbital myositis. The exact mechanism of vision loss in orbital myositis is not understood and merits further investigation. Orbital myositis is a subset of nonspecific orbital inflammatory syndrome. It remains a poorly understood condition that mimics other, more common conditions such as thyroid eye disease and orbital cellulitis. If left untreated, orbital myositis could progress to the point of continued inflammation, enlargement of ocular tissues, ocular ischemia, and optic neuritis. To reverse these symptoms and prevent further progression, a quick diagnosis followed by steroid treatment is imperative.
一位 65 岁的非裔美国男性最初因头痛、眼眶后压力、视力下降、眼前闪光和漂浮物以及双眼复视到急诊就诊。经过全面评估，他被诊断为有先兆偏头痛，并出院回家接受眼科随访。在眼科团队的随访中，他出现了严重的眼眶周围炎症、眼球突出、球结膜水肿和视力下降，左眼最为严重。患者立即住院进一步评估和类固醇治疗。他的视力、眼部症状和身体检查在接受为期 3 天的高剂量静脉类固醇治疗后迅速显著改善。现有文献对于类固醇治疗眼眶肌炎后视力迅速丧失和恢复的情况很少见。眼眶肌炎导致视力丧失的确切机制尚不清楚，值得进一步研究。眼眶肌炎是非特异性眼眶炎症综合征的一个子集。它仍然是一种了解甚少的疾病，模仿其他更常见的疾病，如甲状腺眼病和眼眶蜂窝织炎。如果不治疗，眼眶肌炎可能会发展到持续炎症、眼组织肿大、眼缺血和视神经炎的地步。为了逆转这些症状并防止进一步进展，快速诊断后进行类固醇治疗至关重要。
