Unilateral ptosis due to isolated involvement of the levator muscle in acute orbital myositis

Wheatcroft, S; Elston, John

doi:10.1136/bjo.83.5.e628

Cited by 15 publications

(10 citation statements)

References 4 publications

(4 reference statements)

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“…While ptosis is not uncommonly seen as part of orbital myositis, an isolated presentation of ptosis caused by myositis of the levator palpabrae superioris has only rarely and briefly been described in the literature 8–12. Reduced levator function and lid lag on down-gaze has been reported but these were not a feature in this case 8 10. Lid swelling was also a reported feature that was absent in this case, 9 10 12 as was discomfort or pain 10–12…”

Section: Discussionmentioning

confidence: 64%

“…Reduced levator function and lid lag on down-gaze has been reported but these were not a feature in this case 8 10. Lid swelling was also a reported feature that was absent in this case, 9 10 12 as was discomfort or pain 10–12…”

Section: Discussionmentioning

confidence: 64%

“…Treatment with systemic corticosteroids is the mainstay of therapy, with rapid resolution of symptoms,4 6 although spontaneous remission may occur, and in two of the previous case reports the ptosis resolved without treatment 10 11. Some cases of orbital myositis however become refractory and may require repeated courses of steroid treatment, radiotherapy or immunosuppressive agents.…”

Section: Discussionmentioning

confidence: 99%

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Acute unilateral isolated ptosis

Court

Janicek

2015

BMJ Case Reports

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SUMMARYA 64-year-old man presented with a 2-day history of acute onset painless left ptosis. He had no other symptoms; importantly pupils were equal and reactive and eye movements were full. There was no palpable mass or swelling. He was systemically well with no headache, other focal neurological signs, or symptoms of fatigue. CT imaging showed swelling of the levator palpebrae superioris suggestive of myositis. After showing no improvement over 5 days the patient started oral prednisolone 30 mg reducing over 12 weeks. The ptosis resolved quickly and the patient remains symptom free at 6 months follow-up. Acute ptosis may indicate serious pathology. Differential diagnoses include a posterior communicating artery aneurysm causing a partial or complete third nerve palsy, Horner's syndrome, and myasthenia gravis. A careful history and examination must be taken. Orbital myositis typically involves the extraocular muscles causing pain and diplopia. Isolated levator myositis is rare. BACKGROUND

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Acute unilateral isolated ptosis

Court

Janicek

2015

BMJ Case Reports

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“…Primary manifestations comprise of periocular pain aggravated by ocular movement and restriction of eye movement causing diplopia, and magnetic resonance imaging (MRI) study can detect enlargement of the extraocular muscles . Several case reports and studies have reported the therapeutic value of immunotherapy as steroids and immunosuppressants in orbital myositis and other types of IOIS; however, optimal treatment has not been fully established, and its underlying etiology remains to be elucidated.…”

Section: Introductionmentioning

confidence: 63%

“…Orbital myositis is one of a subgroup of IOIS, formerly termed orbital pseudotumor, which is a non‐neoplastic, non‐infectious, space occupying inflammatory lesion without identifiable local or systemic cause . In our patients, marked improvements were obtained in those with early steroid treatment who started treatment within 1 month from the onset, whereas the outcome was poor in those with late treatment who were introduced a steroid after 6 months.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and therapeutic responses of idiopathic orbital myositis

Ota

Shimizu

Yoshida

et al. 2014

Neurology & Clinical Neurosc

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Background: Orbital myositis is a rare and relatively rapid-onset disease, resulting in inflammation mainly of the single or multiple extraocular muscles, for which the optimal treatment has not yet been fully established. Aim: To evaluate clinical features, therapeutic responses and prognostic factors of idiopathic orbital myositis. Methods: In five patients diagnosed with idiopathic orbital myositis (age of the disease onset 20-81 years), the clinical features, laboratory and radiographic findings, therapeutic response, and prognosis were analyzed retrospectively. Results: All patients showed restriction of ocular movements or orbital pain aggravated by the movements, and one of them showed a visual disturbance caused by the optic nerve compression. Their magnetic resonance imaging showed a thickening of the orbital eye muscles. Two patients who started steroid hormone therapy within 1 month from the disease onset (starting dose: more than prednisolone 50 mg/day) showed quick recovery; both of them had a relapse and they improved again by steroid therapy. Another patient who was started with prednisolone 30 mg/day at the 34th day showed slight residual limitation of ocular movement. However, in the other two patients who received steroid therapy later than 6 months (starting dose: methylprednisolone 1000 mg/day or prednisolone 30 mg/ day), the symptoms were intractable, and one of them underwent surgical treatment. Conclusion: Early initiation of appropriate immunotherapy using a sufficient amount of steroid hormone is essential to improve the prognosis of idiopathic orbital myositis.

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