Rapid Loss and Recovery of Vision Following Steroid Treatment in Orbital Myositis: A Case Report

Abstract

A 65-year-old African American man initially presented to the emergency department complaining of headaches, retro-orbital pressure, decreased vision, white flashes and floaters, and palinopsia of both eyes. After complete evaluation, he was diagnosed with migraine with aura and discharged to home with an ophthalmology follow-up. Upon follow-up with the ophthalmology team, he had developed severe periorbital inflammation, proptosis, chemosis, and vision loss that was greatest on the left side. The patient was immediately hospitalized for further evaluation and steroid treatment. His vision, ocular symptoms, and physical findings dramatically and rapidly improved with a 3-day course of high-dose intravenous steroids. Existing literature is sparse on rapid loss and recovery of vision following steroid treatment for orbital myositis. The exact mechanism of vision loss in orbital myositis is not understood and merits further investigation. Orbital myositis is a subset of nonspecific orbital inflammatory syndrome. It remains a poorly understood condition that mimics other, more common conditions such as thyroid eye disease and orbital cellulitis. If left untreated, orbital myositis could progress to the point of continued inflammation, enlargement of ocular tissues, ocular ischemia, and optic neuritis. To reverse these symptoms and prevent further progression, a quick diagnosis followed by steroid treatment is imperative.