J Korean Ophthalmol Soc.  2012 May;53(5):707-711.

Unilateral Ptosis Due to Isolated Levator Myositis

• Yoon JH
• Moon HS
• Chi M

Abstract

PURPOSE
To present a rare case of idiopathic orbital myositis involving levator palpebrae superioris.
CASE SUMMARY
A 27-year-old male presented with a 1-week history of redness, discomfort, swelling, and drooping of his left upper eyelid. A computed tomography scan showed isolated enlargement of the right superior rectus/levator muscle complex. On examination, there was a left blepharoptosis, although eye movements were normal. The authors treated the patient with 3rd-generation cephalosporin; however, after 3 days, the symptoms did not improve. Subsequently, the patient was diagnosed with idiopathic orbital myositis and treated with oral corticosteroids for 1 month; the symptoms gradually resolved.
CONCLUSIONS
Idiopathic orbital myositis is a subtype of nonspecific orbital inflammation primarily involving the extraocular muscles. Although the exact cause of orbital myositis is unknown, an immune-mediated pathophysiologic mechanism appears to be one of the causes. Medial rectus myositis is the most common, and isolated levator muscle myositis is very rare. The authors of the present study reported a case of orbital myositis involving the levator palpebrae superioris which should be considered a differential diagnosis of blepharoptosis with eyelid swelling.

Keyword

Corticosteroid; Levator muscle; Orbital myositis

MeSH Terms

Adrenal Cortex Hormones
Adult
Blepharoptosis
Diagnosis, Differential
Eye Movements
Eyelids
Humans
Inflammation
Male
Muscles
Myositis
Orbit
Orbital Myositis
Adrenal Cortex Hormones

Figure

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  Figure 1 At first day, the patient shows left upper eyelid ptosis and normal movement of eyes.

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  Figure 2 Coronal and sagittal computed tomographic scans show enlargement of the left superior rectus/levator muscle complex.

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  Figure 3 One month later, the patient shows improvement of left upper blepharoptosis.

Reference

1. Yuen SJ, Rubin PA. Idiopathic orbital inflammation: distribution, clinical features, and treatment outcome. Arch Ophthalmol. 2003. 121:491–499.

2. Kennerdell JS, Dresner SC. The nonspecific orbital inflammatory syndromes. Surv Ophthalmol. 1984. 29:93–103.

3. Garrity JA, Henderson JW, Cameron JD. Henderson's Orbital Tumors. 2007. 4th ed. Philadelphia: Williams & Wilkins;343–360.

4. Rootman J, Nugent R. The classification and management of acute orbital pseudotumors. Ophthalmology. 1982. 89:1040–1048.

5. Birch-Hirschfeld A. Zur diagnostic and pathologic der orbital tumoren. Ber Zusammenkunft Dtsch Ophthalmol Ges. 1905. 32:127–135.

6. Lutt JR, Lim LL, Phal PM, Rosenbaum JT. Orbital inflammatory disease. Semin Arthritis Rheum. 2008. 37:207–222.

7. Dresner SC, Rothfus WE, Slamovits TL, et al. Computed tomography of orbital myositis. AJR Am J Roentgenol. 1984. 143:671–674.

8. Sekhar GC, Mandal AK, Vyas P. Non specific orbital inflammatory diseases. Doc Ophthalmol. 1993. 84:155–170.

9. Scott IU, Siatkowski RM. Idiopathic orbital myositis. Curr Opin Rheumatol. 1997. 9:504–512.

10. Mombaerts I, Koornneef L. Current status in the treatment of orbital myositis. Ophthalmology. 1997. 104:402–408.

11. Mannor GE, Rose GE, Moseley IF, Wright JE. Outcome of orbital myositis, clinical features associated with recurrence. Ophthalmology. 1997. 104:409–413.

12. Slavin ML, Glaser JS. Idiopathic orbital myositis: a report of six cases. Arch Ophthalmol. 1982. 100:1261–1265.

13. Atabay C, Tyutyunikov A, Scalise D, et al. Serum antibodies reactive with eye muscle membrane antigens are detected in patients with nonspecific orbital inflammation. Ophthalmology. 1995. 102:145–153.

14. Trokel SL, Hilal SK. Recognition and differential diagnosis of enlarged extraocular muscles in computed tomography. Am J Ophthalmol. 1979. 87:503–512.

15. Lee JS, Oum BS, Choi CH, Kim HJ. Clinical study of the idiopathic orbital myositis. J Korean Ophthalmol Soc. 1999. 40:1109–1115.

16. Volle E, Levy R, Miléa D, et al. [Idiopathic orbital myositis]. Rev Neurol (Paris). 2001. 157:430–432. [Article in French].

17. Siatkowski RM, Capó H, Byrne SF, et al. Clinical and echographic findings in idiopathic orbital myositis. Am J Ophthalmol. 1994. 118:343–350.

18. Jomura Y, Jokura K, Kuroiwa Y. Orbital myositis with ptosis. Neurological Medicine. 2001. 55:84–86.

19. Lee SK, Song JG. Effect of corticosteroid on orbital pseudotumor caused by orbital myositis. J Korean Ophthalmol Soc. 1991. 32:482–488.

20. Wheatcroft S, Elston J. Unilateral ptosis due to isolated involvement of the levator muscle in acute orbital myositis. Br J Ophthalmol. 1999. 83:631–632.

21. Nikola S, Jasenka B, Ivana KS. Rectus superior and levator palpebrae superioris (RS+LPS) muscle complex myositis. Acta Clin Croat. 2007. 46:317–320.

22. Almekhlafi MA, Fletcher WA. Levator palpebrae myositis. Neurology. 2008. 71:1202.

23. Serop S, Vianna RN, Claeys M, De Laey JJ. Orbital myositis secondary to systemic lupus erythematosus. Acta Ophthalmol (Copenh). 1994. 72:520–523.

24. Barnes C. Orbital myositis--a case report. Aust N Z J Ophthalmol. 1990. 18:251–255.

25. Kim CH, Lim JY, Ahn JH, Jang JW. A case of idiopathic orbital myositis involving all extraocular muscles of both eyes. J Korean Ophthalmol Soc. 2001. 42:1615–1620.

26. Bessant DA, Lee JP. Management of strabismus due to orbital myositis. Eye (Lond). 1995. 9:558–563.

27. Mombaerts I, Koornneef L. Current status in the treatment of orbital myositis. Ophthalmology. 1997. 104:402–408.

28. Hankey GJ, Silbert PL, Edis RH, Nicoll AM. Orbital myositis: a study of six cases. Aust N Z J Med. 1987. 17:585–591.

29. Moorman CM, Elston JS. Acute obital myositis. Eye (Lond). 1995. 9:96–101.

30. Jacobs D, Galetta S. Diagnosis and management of orbital pseudotumor. Curr Opin Ophthalmol. 2002. 13:347–351.

31. Harris GJ. Idiopathic orbital inflammation: a pathogenetic construct and treatment strategy. Ophthal Plast Reconstr Surg. 2006. 22:79–86.

32. Leone CR Jr, Lloyd WC 3rd. Treatment protocol for orbital inflammatory disease. Ophthalmology. 1985. 92:1325–1331.

33. Fraunfelder FT, Roy FH. Current Ocular Therapy. 1995. 4th ed. Philadelphia: W.B Saunders Company;745–748.