A Case of Orbital Myositis Presenting With Dizziness

Abstract

BACKGROUND:Orbital myositis is an idiopathic, inflammatory, non-infectious condition, typically confined to more than one extraocular muscle and usually targeting young females in their third decade.CASE REPORT:We describe a case of orbital myositis uncommonly afflicting an adult male. He initially presented with a sensation of dizziness when turning his head and mobilising, together with right-sided orbital pain that failed to respond to the vestibular sedative cinnarizine. Failure to resolve and development of diplopia initially prompted a working diagnosis of ocular myasthenia gravis. On further investigation using HESS charting, paresis in the inferior and medial rectus and superior oblique ocular muscles of the right eye were elicited correlating with clinical examination. However, the lack of response to low dose steroids and acetylcholinesterase inhibitors, together with a negative screen for myasthenia antibodies, precluded a diagnosis of ocular myaesthenia gravis from being made. Other investigations included a high creatinine kinase and lactate dehydrogenase which indicated pathology in the extraocular muscles themselves. An MRI scan showed normal extraocular muscle thickness while excluding other orbital pathology. Exclusion of a variety of other conditions subsequently led to a diagnosis of orbital myositis.CONCLUSION:Response to high dose steroids consolidated this diagnosis with a rapid response ascertained clinically by resolution of pseudo-vertigo and pain, as well as the ophthalmoplegia with follow-up on HESS charting. We aim to raise awareness of this rare condition that carries a good response to steroids.

Isolated lateral rectus myositis in a nineteen-month-old male patient – case report

“…In the available literature, the authors rarely describe muscle biopsy with histopathological results indicating the presence of plasma cells, lymphocytes and macrophages [3]. Ocular myositis is associated with increased levels of creatine kinase (CK) and LDH [1]. In this case, the LDH level remained normal but the CK level was not tested.…”

“…Ocular myositis (extraocular muscle inflammation) is a non-specific, idiopathic and non-infectious inflammatory condition which affects one or several extraocular muscles [1][2][3]. It usually affects young patients in the second to third decade of life and is more prevalent among females [1,2,4,5].…”

“…Ocular myositis (extraocular muscle inflammation) is a non-specific, idiopathic and non-infectious inflammatory condition which affects one or several extraocular muscles [1][2][3]. It usually affects young patients in the second to third decade of life and is more prevalent among females [1,2,4,5]. The clinical features of ocular myositis include: eyelid edema, conjunctival injection, pain exacerbating during eye movements, diplopia and ptosis [1][2][3][4].…”

“…It usually affects young patients in the second to third decade of life and is more prevalent among females [1,2,4,5]. The clinical features of ocular myositis include: eyelid edema, conjunctival injection, pain exacerbating during eye movements, diplopia and ptosis [1][2][3][4]. A number of other medical conditions occurring in the orbital region, such as inflammation, neoplasms and vascular disorders, may mimic ocular myositis [3].…”

Plasmapheresis in Ophthalmology

“…It is possible to develop an orbital myositis of infectious or non-infectious etiology with several extra-ocular muscles lesion [128]. Ophthalmoplegia may accompany multiple sclerosis, Devic's, Guillain-Barré, Miller-Fisher's and Bikerstaff's syndromes, be one of the first symptoms of myasthenia gravis [129][130][131], and even diabetes [132]. Development of autoimmune damage to the oculomotor muscles can occur.…”