Orbital Inflammation in Pregnant Women

Abstract Objective To analyze overlaps between pregnancy and orbital inflammation (OI). Design Retrospective observational case series. Methods Eight new cases from 1997-2015 and two previously published cases were identified for inclusion in this investigation to provide the fullest clinical picture. Medical records, imaging studies and the results of biopsies were reviewed. Results Three categories of association were discovered: 1) OI arising for the first time during pregnancy (5 cases); 2) OI arising within 3 months of delivery (2 cases); and 3) previously diagnosed OI reactivated or exacerbated by pregnancy (3 cases). One patient had a pre-existent systemic autoimmune disease and another’s was later diagnosed. One patient had attacks during sequential pregnancies. Findings included eyelid swelling and erythema, conjunctival chemosis, pain on eye movement, minimal diplopia, the usual absence of proptosis and general preservation of visual acuity. Imaging studies disclosed extraocular muscle swelling (8 cases), most frequently of a single lateral rectus muscle. There were two cases of dacryoadenitis; one of these and an additional case displayed inflammation of the retrobulbar fat. Corticosteroids effected resolution of most symptoms. Singleton-births were normal with the exceptions of an intrauterine fetal demise due to acrania and a molar pregnancy. Conclusion OI usually affects a single rectus muscle (typically the lateral) and less often the lacrimal gland and is mild when it arises during or after pregnancy. Independent systemic autoimmune disease is an uncommon feature. Corticosteroids were efficacious except in one case with severe orbital scarring. No definitive causal relationships between pregnancy and OI could be established or based on the clinical data.