What are the symptoms of orbital inflammatory pseudotumor

Orbital inflammatory pseudotumor is actually a multiple benign or non-specific inflammation. Patients will show symptoms of conjunctival congestion, edema, or ptosis of the upper face and proptosis of the eyeballs, and may also show problems with ocular movement disorders.

1. Anterior orbital inflammation

Acute or subacute onset. It may manifest as pain, conjunctival congestion and edema, eyelid edema, ptosis, and proptosis; it may be accompanied by uveitis, scleral and eye fasciitis, papillitis, exudative retinal detachment and glaucoma. In patients with sclerotic fasciitis, B-ultrasound examination may reveal irregular inflammatory infiltration and T-shaped signs in the anterior orbit.

2. Diffuse orbital inflammation

The symptoms are similar to those of anterior orbital inflammation, but the eyeballs are more prominent and the condition is more serious. MRI scans can reveal diffuse inflammatory infiltration and orbital fat edema in the orbit.

3. Orbital myositis

The main manifestations are diplopia and eye movement disorders. When the eyeball moves in the direction controlled by the affected muscles, the pain increases. Some patients experience ptosis. The muscle insertion points are congested and edematous, and dark red hypertrophic extraocular muscles can be seen through the conjunctiva. In the late stage of the disease, fibrosis of the extraocular muscles may occur, leading to varying degrees of eye position fixation. Inflammation can affect multiple muscles, with the superior muscles and medial rectus muscle being the most common. MRI scans showed diffuse edema and hypertrophy of the tendons and bellies of the extraocular muscles.

4. Lacrimal gland inflammation

It generally presents with a chronic course, ptosis, and may be accompanied by an "S"-shaped appearance of the eyelid. The eyeball is slightly protruding, displaced downward from the nose, and a mass can be felt at the superior temporal edge of the orbit. MRI scans show enlargement of the affected lacrimal glands, which may be enhanced.

5. Sclerosing inflammation

Onset is slow. This type of pathological histological changes is mainly characterized by proliferation of fibrous tissue. The eyeballs are slightly protruding, the eye position can be fixed in the late stage, and the eye movement is significantly restricted. Compressive optic neuropathy may occur, leading to optic atrophy. Intracranial extension of an orbital pseudotumor may lead to hypopituitarism and multiple cranial nerve palsies.

6. Orbital apex inflammation

In a very small number of patients with inflammatory pseudotumor, the inflammatory lesions mainly involve the orbital apex, and proptosis is generally not obvious. The patient's visual function abnormalities are disproportionate to the ocular inflammation. In the early stages, patients may experience decreased vision, visual field loss, relative afferent pupillary defect, and ocular motility disorders. MRI scans showed that the orbital apex mass showed inflammatory infiltration-like changes.