Orbital Myositis (OM)

Simply Put
Presentation of Orbital Myositis

Presentation of Orbital Myositis

Orbital or Ocular Myositis (OM) is an extremely rare autoimmune disorder which affects the extraocular muscles of the eye, which are muscles that control eye movement. Ocular Myositis frequently manifests with orbital pain and diplopia (double vision).

While OM has no one known cause, there have been cases which have been associated with a variety of non-infectious diseases such as Lupus SLE, Crohn’s disease, and infections of the upper respiratory tract and sinus.

Possible infectious causes for Orbital Myositis have been reported and may include Herpes Zoster, Lyme disease, and Cysticercosis, a rare parasitic infection.

OM primarily impacts young to middle-aged adult women.

Signs of Orbital Myositis

  • Bulging eye
  • Redness
  • Pain, especially with eye movement
  • Feeling of the eye being stuck
  • Double vision
  • Drooping eyelid
  • Restricted eye movement
  • Swelling around the eye

Quick Tips

Many inflammatory, vascular, neoplastic, and infectious conditions that affect the extraocular muscles and other orbital tissue can mimic orbital myositis.

The most important differential diagnoses include thyroid-related eye disease, other orbital inflammatory processes (unspecific idiopathic inflammation, vasculitis, and sarcoidosis), orbital cellulitis, and orbital tumors.

Diagnosing Orbital Myositis

Orbital MyositisThe diagnosis of ocular (ocular) myositis falls within the overall classification of idiopathic orbital inflammatory diseases, defined as non-infective non-specific orbital inflammation without identifiable local or systemic causes.

A specialist in inflammatory eye diseases should be sought out, as the diagnostic process can be very challenging. The cooperation of ophthalmologists and rheumatologists/immunologists will help to achieve a faster diagnosis and likely better treatment options.

The symptoms of OM are often similar to many other diseases which can affect the eye, such as thyroid-related eye disease, tumors, infectious conditions, or inflammatory disorders such as Vasculitis or Sarcoidosis.

An axial and coronal MRI with fat suppression appears to be the best imaging tool to see inflammation of the eye muscles, tendons, and surrounding fat, and to rule out other eye diseases.

It is also common to have a blood test to determine if autoantibodies are present which could indicate specific autoimmune disorders.

Treatment for Orbital Myositis

OM typically responds well to systemic cortisone therapy such as Prednisone.

Some cases which are non-responsive to steroid treatment, are chronic, or are recurrent may require other treatment options including:

  • Disease Modifying Antirheumatic Drugs (DMARDs), which suppress the immune system (Mycophenolate Mofetil, Azathioprine, Methotrexate)
  • T-cell inhibitors (Tacrolimus or Cyclosporine)
  • Radiation therapy
  • Antibiotic therapy
  • Tumor necrosis factor alpha blockers, called TNF or Biologics (Rituxan)
  • Intravenous Immunoglobulin infusions (IVIG)

Complications of Orbital Myositis

A prompt and proper diagnosis, with prompt and proper treatment, can dramatically improve symptoms in the majority of patients and may eliminate the disease altogether, although this is not a cure, as there is no cure at this time. However in some cases, especially in refractory ones, the disease can cause muscle fibrosis. A minority of patients may have recurrences.

The symptoms of OM are often similar to many other diseases which can affect the eye, such as thyroid-related eye disease, tumors, infectious conditions, or inflammatory disorders such as Vasculitis or Sarcoidosis.

An axial and coronal MRI with fat suppression appears to be the best imaging tool to see inflammation of the eye muscles, tendons, and surrounding fat, and to rule out other eye diseases.

It is also common to have a blood test to determine if autoantibodies are present which could indicate specific autoimmune disorders.

.

Learn more about Orbital Myositis

Get Support for OM

Orbital Myositis is really rare. Find others like you and get the support you deserve by joining our Myositis Support Community.

Join Today

Orbital Myositis Research and Articles

Myers (Provencher) LA, Vogelgesang SA, Kardon RH, Gordon LK, Shriver EM. Idiopathic Orbital Myositis: A Treatment Algorithm. EyeRounds.org. June 3, 2016. Available from http://EyeRounds.org/cases/234-Idiopathic-Orbital-Myositis.htm

Toshinobu Kubota (2011). Orbital Myositis.  Idiopathic Inflammatory Myopathies – Recent Developments, Prof.  Jan Tore Gran (Ed.), ISBN: 978-953-307-694-2, InTech, Available from http://www.intechopen.com/books/idiopathic-inflammatory-myopathies-recent-developments/orbital-myositis

Simply Put

“Simply Put” is a service of Myositis Support and Understanding, to provide overviews of Myositis-related medical and scientific information in understandable language.

MSU volunteers, who have no medical background, read and analyze often-complicated medical information and present it in more simplified terms so that readers have a starting point for further investigation and consultation with healthcare providers. The information provided is not meant to be medical advice of any type.

© 2024 Myositis Support and Understanding Association (MSU). All rights reserved. | View our Privacy Policy, Terms, and Non-Discrimination policy. MSU is a charitable organization with 501(c)(3) tax-exempt status. Federal ID #47-4570748.

View COVID-19 resources and updates, and stay tuned to your state, local, and federal health agencies, along with the CDC.

Log in with your credentials

or    

Forgot your details?

Register for Free Membership

Send this to a friend