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Orbital trochleitis: Literature review.

L Collado Sánchez1, I Munuera2, M J Rodrigo Sanjuán2

  • 1Universidad de Zaragoza, Biotech Vision SLP Empresa Spin off de la Universidad de Zaragoza, Instituto de investigación Sanitaria Aragón, Zaragoza, Spain.

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|June 20, 2024
PubMed
Summary

Trochleitis, an inflammation of the orbital pulley, causes significant eye pain and visual disturbances. Corticosteroid injections offer a higher cure rate than NSAIDs for this underdiagnosed condition.

Keywords:
DiplopiaDiplopíaDolorMúsculo oblicuo superiorPainReviewRevisiónSuperior oblique muscleTrochleitisTrocleítis

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Area of Science:

  • Ophthalmology
  • Orbital Diseases
  • Inflammatory Conditions

Background:

  • Trochleitis involves inflammation of the trochlea or orbital pulley, presenting with superomedial orbital pain, hypersensitivity to palpation and eye movements.
  • Symptoms include nocturnal micro-awakenings during REM sleep, diplopia, and potentially Brown's syndrome.
  • Underdiagnosis and misdiagnosis are common due to low prevalence and lack of standardized diagnostic and treatment guidelines.

Purpose of the Study:

  • To review and synthesize current knowledge on trochleitis diagnosis and treatment.
  • To differentiate trochleitis from other causes of trochlear pain.
  • To establish an adequate therapeutic and prognostic approach based on evidence.

Main Methods:

  • Comprehensive literature review of studies on trochleitis.
  • Analysis of clinical and radiological findings.
  • Evaluation of treatment outcomes for various therapeutic interventions.

Main Results:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) show a 77% overall cure rate, decreasing to 30% with motility restriction or diplopia.
  • Intratrochlear corticosteroid injection achieves an 86% overall cure rate, even in severe cases.
  • Corticosteroid injection is effective for NSAID-refractory trochleitis and is considered a primary treatment option.

Conclusions:

  • Accurate diagnosis and differentiation from other trochlear pain entities are crucial for effective management.
  • Intratrochlear corticosteroid injection demonstrates superior efficacy compared to NSAIDs, particularly in complex cases.
  • Further research and consensus on therapeutic protocols are needed to optimize patient outcomes.