| 본문 : Purpose
To report two cases of idiopathic orbital inflammatory(IOI) syndrome which could be misdiagnosed as ptosis
Case summary
Case 1) A 59-year-old male complained about his right upper eyelid swelling and ptosis which had started two weeks before he visited our clinic. His marginal reflex distance 1 was 2mm, 5mm on his right and left eye each. Levator function test turned out to be 8mm on his right eye, 12mm on the left. On blood test, ESR showed 12mm/hr which was a little higher than the upper normal limit(10mm/hr). Other blood tests such as WBC, TG-Ab, TG-Ag, T3, fT4, TSI, TSH, IgG4, IgG, CRP were within normal limits. His right upper eyelid and superior rectus muscle on the right eye seemed swollen by the test of non contrast-enhanced orbital CT and T1 weighted orbit MRI showed high intensity on that same tissue. Under diagnosis of idiopathic orbital inflammation syndrome, he was admitted and treated as intravenous antibiotics and steroid for 1week making his eyelids swelling much improved. On outpatient basis follow-ups, there was no difference between MRI1 on his right eye and the left eye.
Case 2) A 66-year-old woman came to clinic complaining about her both eyelids swelling, ocular pain, and discharge which started 1 week before her visit. There were no other out-of-boundary blood test results, but soft tissue around her right orbit was slightly swollen by non-contrast enhanced orbital CT and orbit MRI FLAIR images showed slightly increased intensity around her right soft tissue. After intravenous antibiotics plus steroid treatment for 5 days, her eyelids with swelling and ptosis were much improved.
Conclusion
Even if common causes of eyelid ptosis in middle-to-old aged patients are involutional ptosis and some other neurological problems, it is important to consider that IOI can also be a possible cause of ptosis. Blood test and imaging study may be helpful to differentiate causes of eyelid ptosis and swelling.
Key words(5)
Idiopathic orbital inflammatory syndrome, ptosis, blood test, CT, MRI |