Prevalence of Idiopathic Orbital Inflammatory Syndrome in Srinagarind Hospital

Abstract

Objective: To evaluate the distribution, clinical signs, clinical symptoms, characteristics of pathology and clinical responds to treatment of idiopathic orbital inflammatory syndrome

Methods:  This study was a 5-years retrospective review of patients with idiopathic orbital inflammatory syndrome in Srinagarind hospital

Result: Totally there were 18 patients, 14 males and 4 females. Ranging of age were from 4-63 years old, and most of them were 41-60 years old. The site of lesions were 10 (52.63%)  on right eye, 5 (26.32%) on left eye and 4 (21.05%) bilateral. Mostly patients present with good visual acuity (VA >6/12) 11 (57.89%) on right eye, 13 (68.42%) on left eye.  The patients complaint with orbital pain 15.79%, double vision 15.79%, vision loss 31.58%, eye lid swelling 10.53%, feeling bulging of the eyes 36.84%.  The presenting clinical signs were proptosis 63.16%  limitation of eye movement 57.89%  lacrimal gland enlargement 31.58% mechanical ptosis 16.67% disc edema 10.53% uveitis 5.26%.  The neuroimaging that mostly used in this study was computed tomography (84.21%), the organs that involved from neuroimaging were lacrimal gland 12 (66.67%), muscle involvement 8 (44.44%), optic nerve sheath 7 (38.89%) and orbital apex and intracranial involvement 6 (33.33%).  For the group that has muscle involvement, mostly was lateral rectus 7 (38.89%).  Others inferior rectus and superior rectus 4 (22.22%), and medial rectus 2 (11.11%)  but no statistical significant (CI:-0.54—0.10;P=0.054).  Treatment modality, most modality be used was oral steroid 16 (84.2%),  the others were intravenous and intralesional steroid. Results of treatment were resolved 15 (78.95%),  recurrent 4 (21.05%) and no recalcitrant be found. There were three types of orbital histopathology found in this study; classical idiopathic orbital inflammatory syndrome 66.67%,  sclerosis idiopathic orbital inflammatory syndrome 16.67%,  and eosinophil idiopathic orbital inflammatory syndrome 16.67%, each type of histopathology did not had statically significant.

Conclusion:  Idiopathic orbital inflammatory syndromes have many presenting symptoms and signs which were not specific so that we need more clue form laboratory and neuroimaging to help for making diagnosis and differentiation from other. Most Idiopathic orbital inflammatory syndromes have a rapidly good response to steroid which sometimes likes hematologic malignancy so biopsy for histopathology is important to make a definite diagnosis.