Pollard Z F
Ophthalmology Section, Scottish Rite Children's Hospital, Atlanta, Georgia, USA.
J Pediatr. 1996 Feb;128(2):230-3. doi: 10.1016/s0022-3476(96)70395-5.
Acute rectus muscle palsy caused by orbital myositis is often confused with infectious orbital cellulitis. The purpose of this article is to clarify the former condition by explaining how it is manifested and treated.
The seven children less than age 11 years in this study were examined after having an acute onset of ocular pain. Physical examination indicated a loss of motility in the field of action of the involved extraocular rectus muscle. Computed tomographic examination confirmed the existence of orbital myositis. Treatment consisted of intravenous or oral administration of corticosteroids.
In all the initial evaluations, computed tomography showed the isolated rectus muscle to be enlarged. In four of the patients in whom the lateral rectus was involved, esotropia was present in the primary position. In the fifth patient with lateral rectus involvement, esotropia was seen only in the field of gaze of the involved lateral rectus muscle. The patient with medial rectus involvement had exotropia, and the patient with superior rectus involvement had hypotropia on the involved side. Each had injection and chemosis of the conjunctiva and Tenon fascia only in the quadrant overlying the involved rectus muscle.
Children with orbital myositis can have an acute rectus muscle palsy. The inflammation and strabismus are exquisitely sensitive to systemic corticosteroid therapy, which produces a rapid resolution of symptoms. If the steroid therapy is discontinued abruptly, the myositis can recur.
眼眶肌炎所致急性直肌麻痹常被误诊为感染性眼眶蜂窝织炎。本文旨在通过阐述眼眶肌炎的表现及治疗方法来明确这种疾病。
本研究中7名11岁以下儿童在急性眼痛发作后接受了检查。体格检查显示受累眼外直肌作用范围内运动受限。计算机断层扫描检查证实存在眼眶肌炎。治疗方法为静脉或口服皮质类固醇。
在所有初始评估中，计算机断层扫描显示孤立的直肌增粗。在4例累及外直肌的患者中，第一眼位存在内斜视。在第5例累及外直肌的患者中，仅在受累外直肌的注视范围内可见内斜视。累及内直肌的患者有外斜视，累及上直肌的患者受累侧有下斜视。每位患者仅在受累直肌上方象限的结膜和眼球筋膜有充血和水肿。
眼眶肌炎患儿可出现急性直肌麻痹。炎症和斜视对全身皮质类固醇治疗极为敏感，症状可迅速缓解。如果突然停用类固醇治疗，肌炎可能复发。
