Headache Medicine 2021, 12(1) p-ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2021.14

Headache Medicine

Image in Headache Medicine

Eye pain in 13-year-old teenager: a case report of idiopathic orbital myositis

Renata Barbosa Paolilo Paula da Cunha Pinho

Department of Neurology, Samaritano Hospital of São Paulo, São Paulo, Brazil

A previously healthy 13-year-old male presented with sporadic headache that evolved to continuous right eye

pain and blurred vision within a week. There was no previous infection or relevant family history. Neurological

examination revealed restricted abduction of right eye and horizontal diplopia. Contrast-enhanced orbital magnetic

resonance imaging (MRI) is shown in Figures 1 and 2. Cerebrospinal uid analysis and extensive laboratory workup

were normal. He was treated with intravenous corticosteroid for 5 days and oral tapering for 2 weeks. Orbital

MRI performed within 2 months resulted normal. After a three-year follow-up, the patient keeps asymptomatic.

Orbital myositis is a non-infectious inammatory condition of unknown etiology.

Pediatric cases account for 6-17% of

all orbital inammatory disorders.

Besides being rare, prompt recognition, diagnosis, and treatment are important.

Axial and coronal orbital MRI is a sensitive diagnostic tool.

Author's Contribution: RBP, data collection, conceptualization and writing; PCP, Data collection, review and editing.

Financing: No

Conflict of interests: No

Renata Barbosa Paolilo. https://orcid.org/0000-0003-3548-8467

Paula da Cunha Pinto. https://orcid.org/0000-0002-9558-2693

References

1. Mombaerts I, Bilyk JR, Rose GE, Mcnab AA, Fay A, Dolman PJ, . . . Harris GJ. Consensus on Diagnostic Criteria

of Idiopathic Orbital Inflammation Using a Modified Delphi Approach.

JAMA Ophthalmol

2017;135(7):769-

776 Doi: 10.1001/jamaophthalmol.2017.1581

2. Briones MR, Morgan GA, Amoruso MC, Rahmani B, Ryan ME and Pachman LM. Decreased CD3-

CD16+CD56+ natural killer cell counts in children with orbital myositis: a clue to disease activity. RMD Open

2017;3(1):e000385 Doi: 10.1136/rmdopen-2016-000385

3. Utsunomiya S, Yamamoto D and Uchiyama T. Orbital myositis presenting with only unilateral orbital pain.

BMJ Case Rep

2017; Doi: 10.1136/bcr-2017-220615

Renata Barbosa Paolilo

renatabpaolilo@gmail.com

Received: March 18, 2021

Accepted: March 30,2021

Keywords:

Orbital myositis

Eye pain

Orbital diseases

Figure 1. Coronal fat-suppressed contrast-enhanced T1 shows

enlarged right medial muscle and mild inltration of the sur-

rounding fat.

Figure 2. Coronal fat-suppressed T2 shows high signal in the

right medial muscle. The classic appearance of extraocular

muscle (EOM) myositis includes a unilateral thickening of one

or two EOMs, often also involving the surrounding fat, tendon

and myotendinous junction.

Edited by

Mario Fernando Prieto

Peres

Marcelo Moraes Valença