Skip to main content

Advertisement

SpringerLink
Log in

Factors associated with multiple recurrences of nonspecific orbital inflammation aka orbital pseudotumor

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Objective

To assess clinical characteristics of patients at risk for recurrent nonspecific orbital inflammation (NSOI).

Methods

This was a retrospective comparison study with a 24-month follow-up, in a clinic-based population in rural India. The medical records at two eye care centers were searched from March 2001–2014. A total of 153 patients with recurrent NSOI, 107 of whom had a single recurrence (Group 1) and 46 of whom had multiple recurrences (Group 2). Clinical and demographic data were compared between both groups. Comparisons of mean values were done with multiple 2-tailed independent T tests, and differences in proportions were compared using Chi-squared tests. A multivariate logistic regression model was used to determine which factors were predictive of patients having multiple recurrences.

Results

Several factors were independently related to multiple recurrences (P < 0.05 for all): age ≤16 years (2.5 OR, 95% CI 1.3–3.6), bilateral disease (3.2 OR 95% CI 1.4–5.1), presence of optic disc edema or T-sign on B-scan ultrasonography (3.9 OR 95% CI 1.8–6.2), sclerosing variant (8.5 OR 95% CI 5.4–11.3), corticosteroid taper <4 weeks long (2.8 OR 95% CI 1.1–4.2), autoimmune disease among 1st degree relatives (2.2 OR 95% CI 1.2–3.3). In patients with recurrent disease, the interval between the initial episode and the first recurrence was predictive of further recurrences: ≤3 months (3.2 OR, 95% CI 2.0–4.5) and ≥12 months (0.21 OR, 95% CI 0.01–0.39).

Conclusion

Younger patients and those with bilateral disease are more apt to have recurrences of NSOI. Other factors that increase the risk of multiple recurrences include a T-sign, optic disc edema, poor initial response to steroids, a sclerosing variant, a recurrence within 3 months, and those who underwent a rapid steroid taper.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mombaerts I, Goldschmeding R, Schlingemann RO, Koornneef L (1996) What is orbital pseudotumor? Surv Ophthalmol 41:66–78. doi:10.1016/S0039-6257(97)81996-0

    Article  PubMed  CAS  Google Scholar 

  2. Mombaerts I, Schlingemann RO, Goldschmeding R, Koornneef L (1996) Idiopathic granulomatous orbital inflammation. Ophthalmology 103:2135–2141. doi:10.1016/S0161-6420(96)30378-3

    Article  PubMed  CAS  Google Scholar 

  3. Reynolds RM (2012–2013) Glucocorticoid excess and the developmental origins of disease: two decades of testing the hypothesis—curt richter award winner. Psychoneuroendocrinology 38:1–11. doi: 10.1016/j.psyneuen.2012.08.012

  4. van der Goes MC, Jacobs JW, Bijlsma JW (2014) The value of glucocorticoid co-therapy in different rheumatic diseases-positive and adverse effects. Arthritis Res Ther 13(16 Suppl 2):S2. doi:10.1093/med/9780199642489.003.0079_update_001

    Article  Google Scholar 

  5. Dinsen S, Baslund B, Klose M et al (2013) Why glucocorticoid withdrawal may sometimes be as dangerous as the treatment itself. Eur J Intern Med 24:714–720. doi:10.1016/j.ejim.2013.05.014

    Article  PubMed  CAS  Google Scholar 

  6. Hodding GC, Jann M, Ackerman IP (1980) Drug withdrawal syndromes—a literature review. West J Med 133:383–391

    PubMed  PubMed Central  CAS  Google Scholar 

  7. Mombaerts I, Koornneef L (1997) Current status in the treatment of orbital myositis. Ophthalmology 104:402–408. doi:10.1016/S0161-6420(97)30301-7

    Article  PubMed  CAS  Google Scholar 

  8. Swamy BN, McCluskey P, Nemet A et al (2007) Idiopathic orbital inflammatory syndrome: clinical features and treatment outcomes. Br J Ophthalmol 91:1667–1670. doi:10.1136/bjo.2007.124156

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Mannor GE, Rose GE, Moseley IF, Wright JE (1997) Outcome of orbital myositis. Clinical features associated with recurrence. Ophthalmology 104:409–413. doi:10.1016/S0161-6420(97)30300-5

    Article  PubMed  CAS  Google Scholar 

  10. Maurer I, Zierz S (1999) Recurrent orbital myositis: report of a familial incidence. Arch Neurol 56:1407–1409. doi:10.1001/archneur.56.11.1407

    Article  PubMed  CAS  Google Scholar 

  11. Yuen SJ, Rubin PA (2003) Idiopathic orbital inflammation: distribution, clinical features, and treatment outcome. Arch Ophthalmol 121:491–499. doi:10.1001/archopht.121.4.491

    Article  PubMed  Google Scholar 

  12. Nieto JC, Kim N, Lucarelli MJ (2008) Dacryoadenitis and orbital myositis associated with lyme disease. Arch Ophthalmol 126:1165–1166. doi:10.1001/archopht.126.8.1165

    Article  PubMed  Google Scholar 

  13. Casteels I, De BC, Demaerel P et al (1991) Orbital myositis following an upper respiratory tract infection: contribution of high resolution CT and MRI. J Belge Radiol 74:45–47

    PubMed  CAS  Google Scholar 

  14. McCarthy JM, White VA, Harris G et al (1993) Idiopathic sclerosing inflammation of the orbit: immunohistologic analysis and comparison with retroperitoneal fibrosis. Mod Pathol 6:581–587

    PubMed  CAS  Google Scholar 

  15. Bijlsma WR, van Gils CH, Paridaens D, Mourits MP, Kalmann R (2011) Risk factors for idiopathic orbital inflammation: a case-control study. Br J Ophthalmol 95:360–364. doi:10.1136/bjo.2009.175190

    Article  PubMed  Google Scholar 

  16. Subramanian PS, Kerrison JB, Calvert PC, Miller NR (2003) Orbital inflammatory disease after pamidronate treatment for metastatic prostate cancer. Arch Ophthalmol 121:1335–1336. doi:10.1001/archopht.121.9.1335

    Article  PubMed  Google Scholar 

  17. Smith JR, Rosenbaum JT (2001) A role for methotrexate in the management of non-infectious orbital inflammatory disease. Br J Ophthalmol 85:1220–1224. doi:10.1136/bjo.85.10.1220

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Bielory L, Frohman LP (1991) Low dose cyclosporine therapy of granulomatous optic neuropathy and orbitopathy. Ophthalmology 98:1732–1736. doi:10.1016/S0161-6420(91)32064-5

    Article  PubMed  CAS  Google Scholar 

  19. Adams AB, Kazim M, Lehman TJ (2005) Treatment of orbital myositis with adalimumab (Humira). J Rheumatol 32:1374–1375

    PubMed  Google Scholar 

  20. Grunwald JE, Daniel E, Huang J, CATT Research Group et al (2014) Risk of geographic atrophy in the comparison of age-related macular degeneration treatments trials. Ophthalmology 121:150–161. doi:10.1016/j.ophtha.2013.08.015

    Article  PubMed  Google Scholar 

  21. Martin DF, Maguire MG, Fine SL, Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group et al (2012) Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 119:1388–1398. doi:10.1016/j.ophtha.2012.03.053

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ciulla TA, Ying GS, Maguire MG, Comparison of Age-Related Macular Degeneration Treatments Trials Research Group et al (2015) Influence of the vitreomacular interface on treatment outcomes in the comparison of age-related macular degeneration treatments trials. Ophthalmology 122:1203–1211. doi:10.1016/j.ophtha.2015.02.031

    Article  PubMed  Google Scholar 

  23. Deschenes J, Murray PI, Rao NA, Nussenblatt RB, International Uveitis Study Group (2008) International Uveitis Study Group (IUSG): clinical classification of uveitis. Ocul Immunol Inflamm. 16:1–2. doi:10.1080/09273940801899822

    Article  PubMed  Google Scholar 

  24. Yan J, Qiu H, Wu Z, Li Y (2006) Idiopathic orbital inflammatory pseudotumor in Chinese children. Orbit 25:1–4. doi:10.1080/01676830500505608

    Article  PubMed  CAS  Google Scholar 

  25. Guerriero S, Di Leo E, Piscitelli D, Ciracì L, Vacca A, Sborgia C, Dammacco R (2011) Orbital pseudotumor in a child: diagnostic implications and treatment strategies. Clin Exp Med 11:61–63. doi:10.1007/s10238-010-0104-7

    Article  PubMed  Google Scholar 

  26. Berger JW, Rubin PA, Jakobiec FA (1996) Pediatric orbital pseudotumor: case report and review of the literature. Int Ophthalmol Clin 36:161–177

    Article  PubMed  CAS  Google Scholar 

  27. Ferrara M, Borrelli B, Greco N, Coppola L et al (2005) Side effects of corticosteroid therapy in children with chronic idiopathic thrombocytopenic purpura. Hematology 10:401–403. doi:10.1080/10245330500168740

    Article  PubMed  CAS  Google Scholar 

  28. Dilber C, Dagdemir A, Albayrak D, Albayrak S, Kalayci AG, Aliyazicioglu Y, Basoglu T (2004) Reduced bone mineral density in childhood chronic idiopathic thrombocytopenic purpura treated with high-dose methylprednisolone. Bone 35:306–311. doi:10.1016/j.bone.2004.04.005

    Article  PubMed  CAS  Google Scholar 

  29. Harr DL, Quencer RM, Abrams GW (1982) Computed tomography and ultrasound in the evaluation of orbital infection and pseudotumor. Radiology 142:395–401. doi:10.1148/radiology.142.2.7054828

    Article  PubMed  CAS  Google Scholar 

  30. Yan J, Wu Z, Li Y (2004) The differentiation of idiopathic inflammatory pseudotumor from lymphoid tumors of orbit: analysis of 319 cases. Orbit 23:245–254. doi:10.1080/01676830490487980

    Article  PubMed  Google Scholar 

  31. Purvin V, Kawasaki A, Jacobson DM (2001) Optic perineuritis: clinical and radiographic features. Arch Ophthalmol 119:1299–1306

    Article  PubMed  CAS  Google Scholar 

  32. Bijlsma WR, Elbert NJ, Kalmann R (2012) The role of biopsy in diagnosing patients suspected of idiopathic orbital inflammation. Curr Eye Res 37:251–253. doi:10.3109/02713683.2011.639476

    Article  PubMed  Google Scholar 

  33. Gordon LK (2006) Orbital inflammatory disease: a diagnostic and therapeutic challenge. Eye (Lond) 20:1196–1206. doi:10.1038/sj.eye.6702383

    Article  CAS  Google Scholar 

  34. Weissler MC, Miller E, Fortune MA (1989) Sclerosing orbital pseudotumor: a unique clinicopathologic entity. Ann Otol Rhinol Laryngol 98:496–501. doi:10.1177/000348948909800702

    Article  PubMed  CAS  Google Scholar 

  35. Abramovitz JN, Kasdon DL, Sutula F, Post KD, Chong FK (1983) Sclerosing orbital pseudotumor. Neurosurgery 12:463–468

    Article  PubMed  CAS  Google Scholar 

  36. Cervellini P, Volpin L, Curri D, Pedrotti M, Benedetti A (1986) Sclerosing orbital pseudotumor. Ophthalmologica 193:39–44. doi:10.1159/000309677

    Article  PubMed  CAS  Google Scholar 

  37. Rubin PA, Foster CS (2004) Etiology and management of idiopathic orbital inflammation. Am J Ophthalmol 138:1041–1043. doi:10.1016/j.ajo.2004.09.032

    Article  PubMed  Google Scholar 

  38. Buckley CD (2011) Why does chronic inflammation persist: an unexpected role for fibroblasts. Immunol Lett 138:12–14. doi:10.1016/j.imlet.2011.02.010

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Jordana M, Särnstrand B, Sime PJ, Ramis I (1994) Immune-inflammatory functions of fibroblasts. Eur Respir J 7:2212–2222

    Article  PubMed  CAS  Google Scholar 

  40. Braich PS, Lal V, Hollands S, Almeida DR (2012) Burden and depression in the caregivers of blind patients in India. Ophthalmology 119:221–226. doi:10.1016/j.ophtha.2011.07.038

    Article  PubMed  Google Scholar 

  41. Braich PS, Almeida DR, Hollands S, Coleman MT (2011) Effects of pictograms in educating 3 distinct low-literacy populations on the use of postoperative cataract medication. Can J Ophthalmol 46:276–281. doi:10.1016/j.jcjo.2011.05.004

    Article  PubMed  Google Scholar 

  42. Hardy TG, McNab AA, Rose GE (2014) Enlargement of the infraorbital nerve: an important sign associated with orbital reactive lymphoid hyperplasia or immunoglobulin g4-related disease. Ophthalmology 121:1297–1303. doi:10.1016/j.ophtha.2013.12.028

    Article  PubMed  Google Scholar 

  43. McNab AA, McKelvie P (2015) IgG4-related ophthalmic disease. Part II: clinical aspects. Ophthal Plast Reconstr Surg 31:167–178. doi:10.1097/IOP.0000000000000364

    Article  PubMed  Google Scholar 

  44. Rootman J (1988) Orbital surgery in disease of the orbit. JB Lippincott, Philadelphia, pp 1–612

    Google Scholar 

Download references

Acknowledgements

We would like to express our gratitude to the clinical staff at the KD Dalmia Eye Hospital and the Balwant Singh Charitable hospital for their efforts in translating the medical record, data acquisition, and acting as a liaison for outside health centers.

Author information

Authors and Affiliations

  1. Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA

    Puneet S. Braich

  2. Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, USA

    Robin K. Kuriakose, Naveen S. Khokhar & Jared C. Donaldson

  3. The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Timothy J. McCulley

Authors
  1. Puneet S. Braich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robin K. Kuriakose
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naveen S. Khokhar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jared C. Donaldson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Timothy J. McCulley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Puneet S. Braich.

Ethics declarations

Conflict of interest

None of the authors have any proprietary interests or conflicts of interest related to this submission.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Braich, P.S., Kuriakose, R.K., Khokhar, N.S. et al. Factors associated with multiple recurrences of nonspecific orbital inflammation aka orbital pseudotumor. Int Ophthalmol 38, 1485–1495 (2018). https://doi.org/10.1007/s10792-017-0610-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-017-0610-7

Keywords

Search

Navigation