Curr Opin OphthalmolNovember 20201 citations

Orbital disease in neuro-ophthalmology.

Dohlman Jenny C, Cestari Dean M, Freitag Suzanne K

View on PubMed DOI: 10.1097/ICU.0000000000000699

AI Summary

This review highlights advances in understanding various orbital diseases, improving monitoring, steroid-sparing therapies, and treatment to prevent vision loss and manage debilitating neuro-ophthalmic conditions.

Abstract

Purpose of review: Orbital disease represents a diverse spectrum of pathology and can result in a variety of neuro-ophthalmic manifestations. The aim of this review is to provide updates on recent advances in our understanding of orbital disease secondary to thyroid eye disease, myositis, IgG4-related disease, sarcoidosis, granulomatosis with polyangiitis and various tumours.

Recent findings: With regards to thyroid eye disease, there have been recent advances in the development of steroid-sparing therapies, new modalities for objectively monitoring disease activity and increased understanding of the role of environmental risk factors. There has been interest in characterizing the clinical course and underlying mechanism of optic nerve disease secondary to orbital disorders, which has led to advances in how we monitor for and prevent permanent vision loss. Increased knowledge of orbital tumour subtype histopathology and the development of novel classification systems has had prognostic value and aided medical decision-making.

Summary

Orbital disease occurs secondary to a wide variety of diseases and can lead to neuro-ophthalmic manifestations with significant morbidity. Advances in our understanding of different subtypes of orbital disease have improved our ability to treat these potentially debilitating conditions.

MeSH Terms

HumansOphthalmologyOptic Nerve DiseasesOrbital DiseasesPrognosisSystemic Vasculitis

Shields Classification

Ch. 4Optic Nerve, Retina, and Choroid

Ch. 27Management of the Glaucoma Patient

Ch. 35Neuroprotection and Other Investigational Drugs

Key Concepts5

Recent advances in the understanding of orbital disease secondary to thyroid eye disease include developments in steroid-sparing therapies, new modalities for objectively monitoring disease activity, and increased understanding of the role of environmental risk factors.

TreatmentReviewn=Not applicableCh28

There has been increased interest in characterizing the clinical course and underlying mechanism of optic nerve disease secondary to orbital disorders, leading to advances in how permanent vision loss is monitored for and prevented.

MechanismReviewn=Not applicableCh5Ch6

Increased knowledge of orbital tumour subtype histopathology and the development of novel classification systems have provided prognostic value and aided medical decision-making for orbital tumours.

PrognosisReviewn=Not applicableCh22

Orbital disease, occurring secondary to a wide variety of diseases including thyroid eye disease, myositis, IgG4-related disease, sarcoidosis, granulomatosis with polyangiitis, and various tumours, can lead to neuro-ophthalmic manifestations with significant morbidity.

DiagnosisReviewn=Not applicableCh8

Advances in the understanding of different subtypes of orbital disease have improved the ability to treat these potentially debilitating conditions.