From the Ophthalmic Plastic Surgery, Mass Eye and Ear (MKY), Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School (MKY), Boston, Massachusetts, USA.
Department of Ophthalmology, University of California-San Francisco (JEL), San Francisco, California, USA.
Am J Ophthalmol. 2024 Oct;266:156-181. doi: 10.1016/j.ajo.2024.05.010. Epub 2024 May 17.
The initial management of patients presenting with orbital inflammatory syndromes varies-with some pursuing a diagnostic workup while others treat without any testing. The evidence behind this rationale is limited. A review of patients with orbital inflammation is performed with an analysis of diagnostic testing to develop a workflow for such patients.
A retrospective review of patients presenting with acute orbital inflammation at a single institution from 2011 to 2020 was conducted.
Orbital imaging was required for inclusion. Patients with high suspicion of neoplasm, bacterial infection, vascular malformation, or thyroid eye disease were excluded. A review of presenting clinical findings, laboratory workup, orbital imaging, and biopsy were performed. Statistical analysis was performed identifying statistically significant diagnostic and treatment maneuvers.
In total, 172 patients met inclusion criteria (66% female, mean age 46 years). The primary clinical presentation was myositis, dacryoadenitis, and infiltrative in 67, 73, and 32 patients (39.0%, 43.0%, 18.6%, respectively). Laboratory studies were conducted in 145 (84%) while biopsy was performed in 55 (32%). Specific orbital inflammation (SOI) was diagnosed in 29 (16.9%) with the most frequent diagnoses being sarcoidosis, IgG4-related disease, inflammatory bowel disease, and systemic lupus erythematosus. The majority (147, 85.5%) was initially treated with steroids, but steroid-sparing agent use was statistically higher in patients with SOI.
In patients presenting with orbital inflammatory syndromes, distinguishing myositis, dacryoadenitis, and infiltrative disease has workup and differential diagnosis impacts. Because SOI is relatively common, sequelae of SOI, and potential steroid-sparing therapy needs, diagnosis via an evidence-based systemic approach is critical. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
患有眼眶炎性综合征的患者的初始治疗方法各不相同，有些患者需要进行诊断性检查，而有些患者则无需任何检查即可进行治疗。这种治疗方案的理论依据有限。本文对某单一机构 2011 年至 2020 年间患有眼眶炎症的患者进行了回顾性分析，并对诊断性检查进行了分析，为这类患者制定了工作流程。
对某单一机构 2011 年至 2020 年间患有急性眼眶炎症的患者进行回顾性分析。
纳入标准为眼眶影像学检查结果异常。排除高度怀疑患有肿瘤、细菌感染、血管畸形或甲状腺眼病的患者。对患者的临床表现、实验室检查、眼眶影像学检查和活检结果进行了回顾性分析。并对有统计学意义的诊断和治疗方法进行了统计学分析。
共有 172 例患者符合纳入标准（66%为女性，平均年龄 46 岁）。主要的临床表现为眼外肌炎、泪腺炎和浸润性病变，分别占 67 例（39.0%）、73 例（43.0%）和 32 例（18.6%）。145 例（84%）患者进行了实验室检查，55 例（32%）患者进行了活检。29 例（16.9%）患者被诊断为特定的眼眶炎症（SOI），最常见的诊断包括结节病、IgG4 相关疾病、炎症性肠病和系统性红斑狼疮。大多数患者（147 例，85.5%）最初接受了类固醇治疗，但 SOI 患者类固醇的使用更为频繁。
在患有眼眶炎性综合征的患者中，区分眼外肌炎、泪腺炎和浸润性疾病对检查和鉴别诊断有影响。由于 SOI 较为常见，因此需要进行基于循证的系统评估，以避免 SOI 的后遗症，并可能需要类固醇节约疗法。
本文的发表由美国眼科学会赞助。
