Original article
Inflammatory Disorders of the Orbit in Childhood: A Case Series

https://doi.org/10.1016/j.ajo.2010.05.012Get rights and content

Purpose

To describe a series of cases of orbital inflammatory disorders in children.

Design

Retrospective case series.

Methods

The medical records of pediatric patients diagnosed with orbital inflammation between September 1, 2002, and December 31, 2008, at Texas Children's Hospital were reviewed. Data collected included age at presentation, final diagnosis, treatment, workup and evaluation, need for biopsy and biopsy results, and involvement of lacrimal gland and muscles.

Results

Twelve cases were identified. Six cases were males and 6 were females with age at presentation ranging from 1.3 to 16.2 years (mean, 11.9 years). The most common presentation was lacrimal gland enlargement, which was bilateral in 3 cases. Other common presenting signs were proptosis, extraocular motility limitation, and pain on eye movement. Half of our patients had systemic complaints at presentation, the most common of which was fever. Four patients were diagnosed as having a systemic cause and 2 of these patients had systemic symptoms.

Conclusions

Idiopathic orbital inflammatory conditions in children are uncommon, but can be associated with systemic conditions. Patients typically have lacrimal gland involvement, pain with eye movement, proptosis, and motility deficits at presentation. Bilateral cases may have a higher incidence of systemic disease.

Section snippets

Methods

A computer search was performed to identify all pediatric patients from 0 to 18 years of age with an orbital inflammatory disorder who had been seen by a pediatric ophthalmologist at our institution between September 1, 2002, and December 31, 2008. We searched for patients who were seen for orbital inflammatory disease, orbital myositis, proptosis, dacryoadenitis, eyelid inflammation, posterior scleritis, and orbital inflammation. Cases of orbital and preseptal cellulitis, tumors of the orbit,

Results

Electronic medical record review revealed 12 patients with orbital inflammatory disorders that had been seen between September 1, 2002, and December 31, 2008. There were 6 males and 6 females, with age at presentation ranging from 1.3 to 16.2 years (mean, 11.9 years; standard deviation, 4.2 years).

The presenting orbital symptoms were enlargement of lacrimal gland (66.7%), proptosis (50%), pain on eye movement (50%), eye movement abnormality (50%), ptosis (25%), diplopia (25%), water eyes

Discussion

Idiopathic orbital inflammatory conditions in children are uncommon, but can be associated with systemic conditions. The clinical findings of idiopathic orbital inflammation are variable and can include diffuse or focal inflammatory infiltration of the lacrimal gland, orbital fat, and extraocular muscles. Patients typically have an abrupt onset of pain, proptosis, and inflammatory signs at presentation. Ptosis, motility dysfunction, chemosis, and optic neuropathy also may be noted.5 Adults

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