Diagnosis of enlarged extraocular muscles

Mombaerts, Ilse; Rose, Geoffrey E.; Verity, David H.

doi:10.1097/icu.0000000000000395

Cited by 43 publications

(41 citation statements)

References 32 publications

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“…The clinical activity score (CAS), based on inflammatory signs and symptoms, has been widely used for GO evaluation and as a criterion and guideline for therapeutic management ( 1 ). However, the acute inflammatory involvement of EOM or orbital fat may fail to be adequately assessed, especially when diplopia or motility impairment is not present ( 5 – 8 ). Moreover, diplopia and strabismus can be induced by either inflammation in the active stage or fatty degeneration and fibrosis in the inactive stage.…”

Section: Introductionmentioning

confidence: 99%

Monitoring and Predicting Treatment Response of Extraocular Muscles in Grave's Orbitopathy by 99mTc-DTPA SPECT/CT

et al. 2021

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Objective: To investigate single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing inflammation in the extraocular muscles (EOMs) and predicting the therapeutic efficacy of periocular glucocorticoid therapy (PGT) for Grave's ophthalmopathy (GO).Materials and Methods: A total of 412 eyes from 206 patients with GO referred for 99mTc-DTPA orbital SPECT/CT were enrolled. Fourteen age- and gender-matched healthy controls (28 eyes) were included. The thickness and uptake ratio (UR) of four EOMs were derived from SPECT/CT. Eighty-six eyes from patients with GO patients received PGT. Changes in SPECT/CT parameters were evaluated between the pre- and post-treatment.Results: 195 eyes and 217 eyes were classified as active and inactive stages by clinical activity score (CAS). Values of the thickness and UR of each EOM, Tmax, and Umax were all significantly higher in the active GO than in the inactive GO and controls (p < 0.01). Among the 86 eyes (48 GO patients) included in the efficacy analysis, 56 eyes and 30 eyes were classified as responders and non-responders. Values of thicknesses and UR of each EOM, the maximum thickness (Tmax), and the maximum UR (Umax) all dropped following PGT in the responders (p < 0.01). Logistic regression analysis identified the Umax as an independent predictor for the responders (p < 0.01). Moreover, the Umax demonstrated incremental predictive value over clinical characters and CAS, as evidenced by the improved area under the curve (0.85 vs. 0.78) and global chi-square (34.12 vs. 18.1).Conclusion:99mTc-DTPA SPECT/CT has the potential to assess inflammatory activity by detecting the involvement of EOMs in GO. Pre-treatment UR provides independent and incremental values for the prediction of PGT treatment response.

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Section: Introductionmentioning

confidence: 99%

Monitoring and Predicting Treatment Response of Extraocular Muscles in Grave's Orbitopathy by 99mTc-DTPA SPECT/CT

et al. 2021

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“…In suspected IOI, the utility of a biopsy is controversial [5][6][7]. Generally, the lesion is biopsied unless it is solely myositic or perineural where the risk of iatrogenic damage outweighs the benefits of tissue diagnosis [8,9]. This process is echoed in the aforementioned diagnosis guidelines for adults that recommend the final step as biopsy if the lesion is non-myositic or an empiric steroid trial if the lesion is myositic [4].…”

Section: Discussionmentioning

confidence: 99%

More Than Meets the Eye: Idiopathic Orbital Inflammation Mimicking Orbital Cellulitis

Lee¹,

Loyal²,

Berkwitt³

2021

Cureus

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An 18-year-old female presented with left eye periorbital swelling, erythema, and pain for three days. Computed tomographic images showed swelling of the medial rectus muscle, and she was diagnosed with orbital cellulitis and initiated on empiric antibiotics. Over the next 48 hours, she did not clinically improve, resulting in an MRI and further workup of infectious, oncologic, endocrinologic, and rheumatologic etiologies was unrevealing and ruled-out malignancy, sarcoidosis, Wegner's, and thyroid eye disease. Given the negative workup, the presentation was determined to be consistent with idiopathic orbital inflammation (orbital myositis variant) via a diagnosis of exclusion. Therefore, the patient was empirically treated with intravenous steroids that produced pronounced improvement within 24 hours. The patient was discharged in improved condition with a prednisone taper and rheumatology follow-up. Idiopathic orbital inflammation is a rare diagnosis of exclusion in pediatrics that merits prompt consideration and work-up if treatment for orbital cellulitis does not progress as expected.

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“…EOM biopsy is indicated when there is a history of malignancy or when the presentation or progression of presumed inflammatory disease is atypical 4 6. To obtain an adequate tissue sample in this setting and therefore demonstrate the histological architecture, open biopsy is required 5. The morbidity associated with biopsy needs to be taken into account; however, this should be weighed against the risks of delaying appropriate management and acknowledging that most lesions can be accessed by minimally invasive techniques with low morbidity 4 7 8…”

Section: Discussionmentioning

confidence: 99%

“…In our institution, EOM biopsies are usually performed under general anaesthesia, with the surgical approach determined by the location of the abnormality 5. The upper lid skin crease is used for lesions involving the levator palpebrae superioris or superior rectus, a lateral canthotomy for the lateral rectus, a swinging eyelid or inferior conjunctival fornix approach for inferior lesions and transcaruncular for medial lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Metastases infiltrated a single muscle in 70% of cases in our study and affected each of the EOMs with similar frequency, with the exception of the levator palpebrae superioris and the inferior oblique. It has been reported that the lateral rectus tends to be affected by metastases, thought to be due to a rich blood supply and adjacent bone marrow density 5. Single muscle involvement in TED is reported to be rare, never involving the lateral rectus, superior rectus or obliques in isolation 5 9.…”

Section: Discussionmentioning

confidence: 99%

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Review of extraocular muscle biopsies and utility of biopsy in extraocular muscle enlargement

et al. 2018

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Diagnosis of enlarged extraocular muscles

Cited by 43 publications

References 32 publications

Monitoring and Predicting Treatment Response of Extraocular Muscles in Grave's Orbitopathy by 99mTc-DTPA SPECT/CT

Monitoring and Predicting Treatment Response of Extraocular Muscles in Grave's Orbitopathy by 99mTc-DTPA SPECT/CT

More Than Meets the Eye: Idiopathic Orbital Inflammation Mimicking Orbital Cellulitis

Review of extraocular muscle biopsies and utility of biopsy in extraocular muscle enlargement

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