目的:眼眶炎症综合征(OIS)患者的初始治疗方法各不相同,有些患者进行诊断检查,而另一些患者则在没有任何检查的情况下进行治疗。这一理由背后的证据是有限的。对患有眼眶炎症的患者进行回顾,并对诊断测试进行分析,以开发此类患者的工作流程。
方法:对2011-2020年在单一机构出现急性眼眶炎症的患者进行了回顾性分析。
方法:纳入时需要轨道成像。高度怀疑肿瘤的患者,细菌感染,血管畸形,或甲状腺眼病被排除。回顾临床发现,实验室检查,轨道成像,进行活检。进行统计分析,以确定具有统计学意义的诊断和治疗策略。
结果:总计,172例患者符合纳入标准(66%为女性,平均年龄46岁)。主要临床表现是肌炎,泪腺炎,在67、73和32例患者中浸润(39.0、43.0、18.6%,分别)。在145(84%)中进行了实验室研究,而在55(32%)中进行了活检。特异性眼眶炎症(SOI)诊断为29例(16.9%),最常见的诊断为结节病,IgG4相关疾病,炎症性肠病,和系统性红斑狼疮.大多数(147,85.5%)最初用类固醇治疗,但在SOI患者中,类固醇保护剂的使用在统计学上较高.
结论:在出现OIS的患者中,区分肌炎,泪腺炎,和浸润性疾病有检查和鉴别诊断的影响。因为SOI比较常见,SOI的后遗症,和潜在的类固醇保留治疗需求,通过基于证据的系统方法进行诊断是至关重要的。
OBJECTIVE: The initial management of patients presenting with orbital inflammatory syndromes varies-with some pursuing a diagnostic workup while others treat without any testing. The evidence behind this rationale is limited. A review of patients with orbital inflammation is performed with an analysis of diagnostic testing to develop a workflow for such patients.
METHODS: A retrospective review of patients presenting with acute orbital inflammation at a single institution from 2011 to 2020 was conducted.
METHODS: Orbital imaging was required for inclusion. Patients with high suspicion of neoplasm, bacterial infection, vascular malformation, or thyroid eye disease were excluded. A review of presenting clinical findings, laboratory workup, orbital imaging, and biopsy were performed. Statistical analysis was performed identifying statistically significant diagnostic and treatment maneuvers.
RESULTS: In total, 172 patients met inclusion criteria (66% female, mean age 46 years). The primary clinical presentation was myositis, dacryoadenitis, and infiltrative in 67, 73, and 32 patients (39.0%, 43.0%, 18.6%, respectively). Laboratory studies were conducted in 145 (84%) while biopsy was performed in 55 (32%). Specific orbital inflammation (SOI) was diagnosed in 29 (16.9%) with the most frequent diagnoses being sarcoidosis, IgG4-related disease, inflammatory bowel disease, and systemic lupus erythematosus. The majority (147, 85.5%) was initially treated with steroids, but steroid-sparing agent use was statistically higher in patients with SOI.
CONCLUSIONS: In patients presenting with orbital inflammatory syndromes, distinguishing myositis, dacryoadenitis, and infiltrative disease has workup and differential diagnosis impacts. Because SOI is relatively common, sequelae of SOI, and potential steroid-sparing therapy needs, diagnosis via an evidence-based systemic approach is critical. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.