Title : Bilateral idiopathic inflammatory orbital syndrome with asymmetric myositis and dacryoadenitis
Abstract:
Purpose: To describe an unusual case of bilateral idiopathic inflammatory orbital syndrome presenting with asymmetric orbital myositis, unilateral proptosis and dacryoadenitis, highlighting its atypical clinical features, diagnosis, and treatment outcomes.
Methods: A 44-year-old female presented with headache, right periorbital pain, progressive bilateral vision loss (right>left), and right eye proptosis. Examination revealed BCVA of 6/12p (right) and 6/9 (left), 5mm right eye proptosis, restricted extraocular movements in the right eye, and intraocular pressure (32mmHg) in the right eye. Pupil Round regular and reactive in both eyes, lens clear in both eyes. Fundus within normal limits in both eyes. Comprehensive ophthalmic examination, laboratory investigations, and orbital MRI were performed. Complete Blood count, Serology, Thyroid profile was within normal limits. ESR was borderline raised. MRI showed bilateral extraocular muscle involvement with predominant right inferior oblique muscle thickening, inflamed retro-orbital fat bilaterally, and hypertrophied right lacrimal gland.
Results: Based on the typical clinical findings and investigations, a clinical diagnosis of Bilateral Idiopathic inflammatory Orbital Syndrome with Asymmetric Myositis and Dacryoadenitis was made.
Conclusion: This case highlights the importance of considering idiopathic inflammatory orbital syndrome in the differential diagnosis of asymmetric bilateral extraocular muscle involvement with unilateral proptosis. The asymmetric presentation, tendinous insertion involvement, and adjacent fat infiltration favor idiopathic inflammatory orbital syndrome over Graves' orbitopathy. Prompt corticosteroid therapy resulted in symptomatic improvement and visual recovery, though motility restrictions persisted. This atypical bilateral presentation with asymmetric involvement adds to the literature on idiopathic inflammatory orbital syndrome.
