Sharp Stabbing Pain in Eye that Comes and Goes

Why Do I Have a Stabbing Pain in My Eye that Comes and Goes?

A sharp stabbing pain in your eye that comes and goes can be worrying. There are many possible causes ranging from debris in your eye to serious conditions like glaucoma. Without treatment, your eye pain could result in vision loss. We don’t want that to happen!

In this article, we’ll cover the most common causes of eye pain as well as some of the rare conditions that may lead to sharp stabbing pain in the eye that comes and goes.

Key Points

• Most cases of sharp stabbing pain in the eye are caused by a foreign body in the eye or inflammation.
• Less common causes of sharp stabbing pain in the eye that comes and goes are cluster headaches and angle-closure glaucoma.
• See a doctor immediately if you experience sudden severe eye pain.

Causes of Sharp Stabbing Pain in Eye that Comes and Goes

Your sharp eye pain may be caused by a number of factors such as debris, a missing contact lens, inflammation, cluster headache, or glaucoma.

The only way to know for sure what’s causing your stabbing eye pain and how to treat it is with a visit to your eye doctor (optometrist or ophthalmologist). To understand more about your symptoms, read on to learn about the many possible causes of eye pain.

However, if you’re experiencing sudden severe eye pain, especially if it occurs with a severe headache, contact your doctor immediately.

Pain Caused by Debris in the Eye

One common cause of sharp pain in the eye is when debris enters and gets stuck temporarily in the corners of the eye or under an eyelid. You may feel a sharp stabbing pain in the eye that comes and goes as you blink, or it may be constant.

To treat, wash your hands and splash water or saline solution into the eye affected by debris. This helps your eye wash out the foreign object naturally. The debris in your eye may be something minor like an eyelash. However, if you get potentially harmful debris in your eye in the workplace, you may need a more thorough eye flush. You should see your on-site health care provider or your own eye doctor.

While you’re outdoors during the summer months, take caution to avoid firework debris or sand getting in your eyes. Your children can experience eye pain while playing with unsafe toys, especially around the holidays.

If debris remains in your eye, it can scratch the cornea (the clear part of the eye in front of your iris) and cause a corneal abrasion. A corneal abrasion is a painful scratch on the cornea that requires a visit to your optometrist or ophthalmologist. Without treatment, a corneal abrasion can cause increasing pain and eye infection.

Contact Lens Stuck in Your Eye

Millions of people wear contact lenses, and most will get a lens stuck in their eye at some point. It’s frustrating and can cause some mild eye pain and discomfort such as burning and redness. There’s no need to panic though because your contact lens can’t get lost behind your eye.¹

To remove a contact lens stuck in your eye, first wash your hands and then moisten your eye with artificial tears. The lubrication may loosen the lens and move it to a place where you can easily remove it. If not, gently stretch your eyelid upwards and to one side and look underneath. When you find the lens, gently nudge it out of your eye with a clean fingertip.

For more on removing soft or hard contact lenses, read How to Tell if a Contact Lens is Still in Your Eye.

To avoid eye pain caused by wearing contact lenses:

• Only wear contact lenses fitted by your eye doctor
• Avoid colored lenses purchased without a prescription
• Rest your eyes occasionally by switching to eyeglasses
• Follow all care and replacement instructions provided by your eye doctor

Sleeping with contact lenses can cause a corneal ulcer. A corneal ulcer is a painful open sore on the cornea that can lead to vision loss. Treatment for corneal ulcers may include antibiotic drops and steroids.²

Eye Pain Caused by Dry Eye Disease

Dry eye disease is a common condition caused by not having enough tears or tears evaporating too quickly, or in most cases, both. ³

With dry eye disease, you may experience burning or stinging eye pain, as well as blurry vision or excessive tearing. Dry eye disease can be caused by age, certain oral medications, hormonal changes, glaucoma drops, contact lens wear, use of digital screens, low-humidity environments, eye surgery, and certain medical conditions.³

Treatment starts with a daily eyelid hygiene routine. You may also try preservative-free artificial tears to lubricate dry eyes and ease symptoms and make a few simple lifestyle changes as well. Eat a balanced diet, drink plenty of water, and fill any dietary gaps with CorneaCare eye vitamins and omega-3 supplements to keep your eyes healthy.³

Here at CorneaCare, we specialize in dry eye and invite you to take our free Dry Eye 101 course to learn more about this chronic, yet treatable condition.

Migraine Headaches

Sharp stabbing pain in the eye that comes and goes may occur with migraine, a common condition affecting 39 million Americans. Migraine symptoms may last a day or up to a week during each episode.⁴

You may have additional symptoms with a migraine headache, including:⁴

• Sensitivity to light and sound
• Flashing lights in vision
• Dizziness
• Loss of coordination or weakness
• Nausea and vomiting
• Mood changes
• Difficulty concentrating

Though the cause of migraine isn’t fully understood, certain triggers have been identified. These include stress, sleep deprivation, certain foods, alcohol, and weather changes. Treatment of migraine involves a combination of therapies to reduce and prevent symptoms.⁴

Painful Cluster Headaches

Cluster headache is a less common headache disorder that causes severe sharp pain often around the eye. Cluster headaches are considered the most painful of headaches causing burning, stabbing pain above or behind one eye or at the temple on one side of the head.⁵

With cluster headaches, the pain is so bad you may find it hard to rest. By contrast, a migraine sufferer is more likely to retire to a darkened room to lie down. Cluster headaches, and related eye pain, can last 15 minutes to 3 hours and recur frequently over days or weeks. Pain-free periods can be months to years in length.^5,6

Treatment for cluster headaches includes corticosteroids, high-flow oxygen, or medication.⁶ 

Eye Pain Caused by Inflammation

Inflammation in part of your eye can cause sharp stabbing pain that comes and goes. Swelling and fluid buildup can cause tissue damage and vision loss. There are many different types of eye inflammation you may experience which we’ll cover below.

Optic neuritis

Optic neuritis is inflammation of your eye’s optic nerve. This eye condition is often caused by damage to the optic nerve by an abnormal immune response.⁷

With optic neuritis, you may notice your eye pain increases when you’re hot, such as during exercise. You may also have the following symptoms:⁷

• Pain with eye movement
• Eye pain at the back of the eye
• Blurred or dimmed vision
• Colors appear faded

If you experience these symptoms, it’s important to see your eye doctor right away to prevent vision loss. Optic neuritis typically requires intravenous and oral steroids to treat. It’s also important to manage the underlying condition that caused optic neuritis.⁷

Uveitis

Uveitis is inflammation of the uvea (the middle layer of the eye) occurring in one or both eyes. This condition may also affect the lens, retina, optic nerve, and vitreous humor (the gel-like substance that gives your eye its shape).⁸

There are different types of uveitis including the less serious iritis, also called anterior uveitis, and the less common posterior uveitis.⁸

In addition to eye pain, swelling of the uvea can cause redness, blurred vision, light sensitivity, and floaters in your vision. Uveitis can cause damage resulting in vision loss.⁸

Your eye doctor may prescribe steroids to reduce swelling and eye pain while preventing further vision problems.

Scleritis and Episcleritis

Scleritis is severe inflammation of the sclera (the white outer area of the eye). While rare, scleritis can develop due to medication side effects, infection, or autoimmune diseases such as Lyme’s or Rheumatoid arthritis.⁹

A similar condition called episcleritis is much more common and usually milder. Inflammation of the episclera (the thin layer between the sclera and the surface of the eye) causes mild to severe eye pain. Your eye pain may be worse with eye movement or during the night. Other symptoms of episcleritis may include light sensitivity, watering eyes, blurred vision, and redness.⁹

Treatment depends on the underlying cause and the severity of symptoms. In general, artificial tears will resolve episcleritis while treatments for scleritis may include corticosteroids, NSAIDs, immunosuppressives, or biologics.⁹

Blepharitis

Blepharitis is inflammation of the eyelid often caused by allergies, an overgrowth of bacteria, or an infestation of mites. Symptoms include mild discomfort, crusty eyelashes, redness, and itchiness. However, blepharitis can flare up and cause more intense pain due to the development of a stye or chalazion.¹⁰

Consistent eyelid hygiene can help reduce eye pain and discomfort related to blepharitis. When blepharitis fails to respond to treatment, Demodex (parasitic mites in your eyelashes and tear glands) may be the cause. Continue your eyelid hygiene routine and see your eye doctor for treatment, which may include antibiotic eye drops.¹⁰

Sinus infection

Sinusitis, or inflammation of the sinuses, is usually caused by the common cold. While not an eye condition, acute sinusitis can cause pain around the eyes as well as nasal congestion and discharge. You may also have symptoms such as headache, earache, cough, fever, and fatigue.¹¹

Acute sinusitis usually resolves in 7-10 days.¹¹ If your symptoms persist for 12 weeks or more, you may have chronic sinusitis. Chronic sinusitis will require treatment by your doctor to relieve symptoms and prevent vision loss and further infection. ¹²

Tolosa-Hunt syndrome

Tolosa-Hunt syndrome is a rare medical condition that may be due to eye inflammation in certain areas. Symptoms include severe eye pain that occurs randomly. In most cases, only one eye is affected.¹³

You may experience pain with eye movement or even temporary paralysis in the eye. With Tolosa-Hunt syndrome, you may also have headaches, double vision, fatigue, or a drooping eyelid. Treatment usually involves oral steroids taken over a period of 3-4 months.¹³

Glaucoma causes damage to the optic nerve and can lead to vision loss and blindness. There are three forms of glaucoma: open-angle, normal-tension, and angle-closure glaucoma. In the U.S., the most common type is open-angle glaucoma with symptoms that develop slowly.¹⁴

However, with the less common angle-closure glaucoma, fluid builds up in the front of the eye quickly causing intense and sudden pain due to elevated eye pressure. Symptoms develop rapidly and you may also experience a severe headache, blurred vision, nausea, and see halos around bright lights.¹⁴

Angle-closure glaucoma is a medical emergency requiring immediate medical attention. An eye doctor may drain the excess fluid, do a laser procedure, and prescribe medication to reduce eye pressure and prevent further damage to the eye.

When to See Your Doctor for Sharp Stabbing Pain in Eye that Comes and Goes

Contact your eye doctor immediately if you experience sudden severe eye pain with headache, nausea, or vomiting. Intense or persistent eye pain can indicate a serious medical condition that requires treatment.

Having regular eye exams can help prevent problems.

Putting It All Together

Sharp stabbing pain in the eye that comes and goes can be annoying and cause concern. If severe eye pain occurs or persists, see your eye doctor immediately.

For a daily eyelid hygiene routine to soothe your symptoms, try CorneaCare’s Rest Self-Heating Warm Compress and CorneaCare’s Rise Eyelid Wipes.

When you take good care of your eyes and your overall health, you reduce your risk of experiencing serious eye pain.

What’s Next

For more on eye pain, check out Feels Like Something in My Eye and My Eye Hurts When I Blink.

Eye injuries – foreign body in the eye

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Summary

Read the full fact sheet

• A foreign body is an object in your eye that shouldn’t be there, such as a speck of dust, a wood chip, a metal shaving, an insect or a piece of glass.
• Don’t try to remove a foreign body from your eye yourself – go straight to your doctor or the nearest hospital emergency department for help.
• With the right care, most injuries from a foreign body in the eye heal without further problems

About foreign bodies in eyes

A foreign body is an object in your eye that shouldn’t be there, such as a speck of dust, a wood chip, a metal shaving, an insect or a piece of glass. The common places to find a foreign body are under the eyelid or on the surface of your eye.

Those most at risk of getting a foreign body in the eye are tradespeople such as labourers, woodcutters, fitters and turners, boilermakers, people hammering metal on metal, gardening and using motorised tools. Don’t try to remove a foreign body from your eye yourself. Go straight to your GP (doctor), optometrist or the nearest hospital emergency department for help.

Symptoms of foreign bodies in eyes

Symptoms of a foreign body in the eye include:

• sharp pain in your eye followed by burning and irritation
• feeling that there is something in your eye
• watery and red eye
• scratchy feeling when blinking
• blurred vision or loss of vision in the affected eye
• sensitivity to bright lights
• bleeding into the white of the eye (subconjunctival haemorrhage).

Complications of foreign bodies in eyes

Most injuries from a foreign body in the eye are minor and usually heal without further problems given the right care. Possible complications include:

• infection and scarring – if the foreign body is not removed from your eye, it may lead to infection and scarring. For example, metal objects react with the eye’s natural tears and rust forms around the metal. This is seen as a dark spot on the cornea (the clear window at the front of the eye) and can cause a scar that may affect your vision. Once it is removed, symptoms should improve
• corneal scratches or abrasions – a foreign body may scratch the cornea, which is the clear membrane on the front of the eye. Commonly, the foreign body is trapped under the upper eyelid. With the right care, most corneal abrasions – even large ones – heal within 48 hours. In some cases, however, they can lead to a long-term problem known as recurrent corneal erosion, which may occur even years after the original injury
• ulcer – sometimes a scratch on the cornea doesn’t heal. A defect on the surface of your eye (ulcer) may form in its place. This could affect your vision or lead to an severe infection
• penetration of the eye – sometimes a projectile object can pierce the eye and enter the eyeball, causing serious injury and even blindness
• corneal scarring –can cause permanent visual impairment.

Treatment of foreign bodies in eyes

Medical treatment generally includes:

• The doctor or nurse checks your vision.
• Once they find the foreign body, they gently remove it after numbing the eye with anaesthetic eye drops. If it’s central or deep, they will arrange for you to see an ophthalmologist (specialist eye doctor) to have it removed.
• Your eye may be washed with saline (sterile salt water) to flush out any dust and dirt.
• X-rays may be done to check whether an object has entered your eyeball or orbit.
• Your eye may be patched to allow it to rest and any scratches to heal. Patching the eye is not necessary, however some still do
• You must not drive until the eye patch is removed and your vision has returned to normal.
• Your doctor may want to see you again to check that your eye is healing and that your vision is all right. You should not miss this appointment
• If there are any serious problems, or a residual rust ring, you will be sent to an ophthalmologist.

Eye drops and ointments

General suggestions on how to use eye drops and ointments include:

• Wash your hands before touching your eyes.
• Rest your finger on your cheek and pull down the lower eyelid.
• Tilt your head back and drop the liquid in behind your lower eyelid.
• For ointment, smear a small amount along the inside of the lower eyelid. Make sure that the nozzle doesn’t touch the eye. Generally drops are used during the day and ointment at night.
• Continue with the treatment until your eyes have healed.
• Store all drops and ointments as instructed on the box or container and keep them out of reach of children.
• Some drops contain drugs or preservatives that damage contact lenses. Do not wear contact lenses until instructed by your doctor.

When to seek urgent medical help for foreign bodies in eyes

See your doctor or go to the emergency department of your nearest hospital if:

• you still have marked pain and watering after the object has been removed, there will be some discomfort while the eye is healing
• you have visual disturbance
• clear or bloody fluid is coming from your eyeball
• you are concerned for any other reason.

Self-care at home after treatment for foreign bodies in eyes

Be guided by your doctor, but suggestions include:

• You must not drive with an eye patch on – it can be very difficult to judge distances properly.
• You may take the patch off – usually the next day, or as instructed by your doctor.
• If you have some discomfort in the eye, you can take pain-relieving medication that contains paracetamol or ibuprofen. Follow the instructions on the packet carefully.
• Avoid working with machinery or at heights.
• You may be advised to use drops or ointment to stop infection. Follow your doctor’s advice as to how often to put them in. You will need to continue the treatment until your eye has healed.

Prevention of foreign bodies in eyes

The best way to prevent a foreign body from getting in your eye is to protect your eyes.

Suggestions include:

• Always wear safety glasses when working in dusty or windy areas, and especially when working in a place where flying debris is likely.
• Use safety glasses or goggles with close-fitting side shields. Regular sunglasses or corrective glasses are not enough.
• Don’t stand or walk near anyone who is grinding, drilling, hammering, using lawn mowers and other gardening tools
• Wear safety glasses when playing some sports such as tennis or squash.

Where to get help

• In an emergency, call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor)
• Ophthalmologist
• Your manager or supervisor
• Your elected occupational health and safety (OH&S) representative and your workplace OH&S coordinator
• WorkSafe VictoriaExternal Link. Tel. (03) 9641 1555 or 1800 136 089 (toll free) – for general enquiries
• WorkSafe Victoria Emergency Response LineExternal Link Tel. 13 23 60 – to report serious workplace emergencies (24 hours, 7 days)

• Acute eye injuries in childrenExternal Link, Royal Children’s Hospital, Melbourne.

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Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 05-06-2023

Myositis of the orbit. What is orbital myositis?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Orbital myositis is an acute or chronic inflammation of the oculomotor muscles. The main symptoms of the disease are bursting pain in the periorbital region, muscle weakness, diplopia, and limited mobility of the eyeball. The palpebral fissure is narrowed, the eyelids are swollen. Ophthalmoscopy, biomicroscopy, ultrasound, tonometry, gonioscopy, CT of the orbits and brain are used to make a diagnosis. The tactics of treatment is reduced to the appointment of antibiotics, angioprotectors, NSAIDs, antihistamines, hormonal drugs and radiotherapy. After stopping the acute process, electrophoresis is applied.

ICD-10

M60 Myositis

• Causes
• Pathogenesis
• Classification
• Symptoms of orbital myositis
• Complications
• Diagnostics
• Treatment of orbital myositis
• Prognosis and prevention
• Prices for treatment

General

Myositis of the orbit is a disease in which one or more external muscles of the eye are affected. The pathology was first described in 1903 by the American scientist G. Gleason. According to statistics, the primary idiopathic variant occurs in 33% of patients suffering from myositis. The secondary form accounts for 67% of cases. Often, pathology is considered in the general structure of the pseudotumor of the orbit. The development of modern diagnostic methods in ophthalmology has reduced the frequency of enucleation by 27%. The idiopathic variant of the disease is more often diagnosed in males after 40 years of age. Secondary damage to the muscles of the orbit occurs in all age groups.

Myositis of the orbit

Causes

The etiology of this disease is not fully understood. Scientists believe that the primary form is based on an autoimmune process in which skeletal muscles are damaged. At the same time, it remains unknown why exactly the external muscles of the eyeball are involved in this process. The main causes of secondary inflammation of the oculomotor muscles are:

• Traumatic injuries. Direct trauma to the muscles or bone walls of the orbit is complicated by secondary myositis, which is due to local damage to muscle fibers. Pathology can occur against the background of contusion of the eye.
• Infectious diseases. The starting factor is the flu, tonsillitis, rheumatism. Toxins or decay products formed during syphilis and toxoplasmosis of the eye have tropism for myocytes. After etiotropic treatment, all symptoms of pathology disappear.
• The impact of physical factors. The onset of symptoms of myositis is often preceded by hypothermia or a burn. With the formation of post-burn scars, symptoms cannot be eliminated.
• Intoxication of the organism. Transient myositis is one of the frequent manifestations of drug or alcohol poisoning. Intoxication with pesticides under production conditions (mercury vapor, lead) also potentiates the development of the disease.
• Non-observance of hygiene rules. Neglect of eye hygiene contributes to the penetration of pathological agents into the orbital cavity. Cosmetics that remain on the skin during untimely removal of makeup have a toxic effect on the structures of the eyeball.
• Iatrogenic effect. The clinical picture develops in the early or late postoperative period. Surgical intervention for the correction of strabismus is often complicated by inflammation of the oculomotor muscles.

Pathogenesis

The mechanism of development of primary idiopathic myositis has not been elucidated. In the pathogenesis of the secondary form, the type of triggering factor directly depends on the etiology. In case of injuries or intraoperative muscle damage, the pathological process is triggered by pro-inflammatory agents (interleukins 1, 2, 6, 8, interferon gamma, tumor necrosis factor a). The external muscles of the eye during the infectious genesis of the disease are affected by the toxins of the pathogen and the decay products of the surrounding tissues. Acute intoxication with ethanol and narcotic substances leads to a decrease in skeletal muscle tone. Over time, atony is replaced by spasm, convulsive twitches, which potentiate the development of myositis. The basis of inflammation of the muscles of the orbit during hypothermia is a neurogenic mechanism.

Classification

Taking into account the cause of development, primary idiopathic and secondary myositis are distinguished. The etiology of the primary form remains unknown, the secondary variant occurs against the background of other pathological conditions and diseases of intraorbital localization. According to the clinical classification, the following types of the disease are distinguished:

• Sharp. It is distinguished by a sudden onset and positive dynamics with timely treatment. Clinical symptoms are leveled independently for 6 weeks. Relapses are not observed.
• Chronic. The duration of the course is more than 2 months. Patients often claim that symptoms have been present for many years. Periods of exacerbations alternate with short-term remissions. The chronic course is most characteristic of the idiopathic form of the disease.

Eye CT. On the left, there is a pronounced thickening of the lower (red arrow) and internal (blue arrow) rectus oculomotor muscle, comparable to their inflammation.

Symptoms of orbital myositis

In the idiopathic form, the first manifestations occur against the background of complete well-being. Patients complain of acute pain in the orbit, a feeling of severe muscle weakness. Visually determined swelling of the eyelids. The orbital fissure narrows due to secondary ptosis. The mobility of the eyelids and the eyeball is sharply limited or impossible. With a unilateral lesion, patients note double vision. The pain syndrome increases with the movement of the eyes in the direction of the lesion. The phenomenon of exophthalmos progresses very quickly. An increase in eye muscles in volume is accompanied by a feeling of bursting pain in the orbit.

On the side of the lesion, a headache appears, which intensifies when trying to move the eyeballs. The conjunctiva is hyperemic. The line of transition of the orbital conjunctiva into the palpebral conjunctiva is smoothed due to edema. Visual impairment occurs only with compression of the ONH in patients with a high degree of exophthalmos. Clinical manifestations increase with general hypothermia of the body, emotional overstrain. In severe cases, a slight increase in body temperature, swelling of the entire periorbital zone is possible.

In secondary myositis of the orbit, there is a clear relationship between the development of symptoms of the disease and the action of certain factors (hypothermia, correction of strabismus, intoxication). With a traumatic or iatrogenic genesis of the pathology, the reposition of the eye is practically impossible. In patients with intoxication, the symptoms are temporary, and the elimination of the action of the etiological factor makes it possible to achieve stable clinical remission. For secondary myositis that occurs against the background of hypothermia, a recurrent course is often characteristic.

Complications

In the absence of timely treatment, cicatricial-atrophic changes occur, which practically do not undergo reverse development. Most patients develop ophthalmohypertension resistant to antihypertensive therapy. With a high degree of severity, signs of stagnation of the optic nerve head are observed, a subsequent transition to total atrophy is possible. A progressive decrease in visual acuity causes amaurosis. The chronic form is complicated by restrictive myopathy. Retrobulbar fiber can be replaced by fibrous or cartilaginous tissue.

Diagnostics

The first step in the diagnosis is a physical examination of the patient. Visually, exophthalmos is determined in combination with swelling of the periorbital zone. Exophthalmometry can be used to measure the degree of protrusion of the eyeball. In infectious myositis, the causative agent of the pathology is identified using serological methods. Specific research methods include:

• Ultrasound of the eye. When conducting ultrasound in B-mode, an increase in the volume of the eyeball is determined. The echogenicity of the affected muscle is reduced. Splitting of echo signals from the fundus is noted.
• CT scan of the brain and orbits. The affected muscle is spindle-shaped thickened. When examining the orbit in the axial projection, exophthalmos of moderate severity is detected. The volume of muscle tissue and eyelids is increased. The retrobulbar space is not changed.
• Non-contact tonometry. Intraocular pressure is increased. With additional electronic tonography, there are no changes in the circulation of intraocular fluid.
• Biomicroscopy of the eye. When examining the anterior segment of the eyeball, reporting and injection of conjunctival vessels are revealed. The transparency of the cornea is not reduced. The relief of the iris is preserved.
• Gonioscopy. The anterior chamber of the eyes is medium in size. The transparency of aqueous humor is complete. With the traumatic nature of the disease, an admixture of blood is determined in the intraocular fluid.
• Ophthalmoscopy. When examining the fundus, a pale pink optic disc with clear boundaries is visualized. The arteries are constricted. Macular reflexes are preserved. A “transverse band” is found on the retina.

Differential diagnosis is carried out with neoplasms of the orbit and endocrine ophthalmopathy. With a progressive tumor of the orbit, the pain syndrome is less pronounced, the relationship with eye movements is practically not traced. With myositis, the muscles are affected along the entire length, while with endocrine ophthalmopathy this occurs only in limited areas.

CT scan of the orbits (axial section, same patient). On the left (red arrow) there is an asymmetric inflammatory thickening of the inferior rectus muscle.

Treatment of orbital myositis

Therapeutic tactics depend on the causes of the disease. Etiotropic therapy is used only when myositis occurs against the background of an infectious pathology. In case of traumatic genesis, surgical intervention is performed, aimed at restoring the integrity of the affected muscle. Conservative therapy of the disease includes:

• Antibiotics. In the treatment of myositis, broad-spectrum antibacterial drugs are used. Medicines are administered retrobulbarno. A short course of antibiotic therapy lasting 5-7 days is recommended.
• Non-steroidal anti-inflammatory drugs. Medicines of this group are highly effective with mild severity of pathology. NSAIDs are prescribed for acute course or during exacerbations.
• Hormonal preparations. Shown in severe or complicated course and a tendency to frequent relapses. Glucocorticosteroids are often used in the treatment of idiopathic myositis in the absence of the effect of NSAIDs.
• Angioprotectors. A vasoconstrictor prevents excessive exudation and increased edema. Strengthening the vascular wall avoids the development of retinal complications.
• Radiotherapy. It is used for the treatment of resistant forms of the disease and for the prevention of relapses in case of insufficient effectiveness of the classical treatment regimen. Irradiation is carried out with a dose of 20 Gy on the lateral wall of the orbit.

After the elimination of the acute inflammatory process, physiotherapy is prescribed. Alternately, electrophoresis of antibacterial drugs is used in combination with antihistamines and glucocorticosteroids. In parallel, osmotherapy is carried out. Antihypertensive drugs are ineffective.

Prognosis and prevention

The prognosis for acute orbital myositis is favorable. In a chronic course, relapses of the disease are possible. Specific preventive measures have not been developed. Non-specific prevention is reduced to observing safety precautions (use of glasses, masks) when working in a production environment, timely removal of decorative cosmetics. The patient should be under dynamic observation by an ophthalmologist for three months after the relief of symptoms. The development of repeated attacks requires the appointment of anti-relapse therapy with radio wave methods.

Sources

1. treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

   causes, symptoms, diagnosis and treatment in Moscow at the Center for Surgery “SM-Clinic”

   Ethmoiditis: causes, symptoms, diagnosis and treatment in Moscow at the Center for Surgery “SM-Clinic”

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   Etmoiditis

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   About disease

   Ethmoiditis is an inflammatory lesion of the cells of the ethmoid bone, lined with a mucous membrane. The disease can occur in acute, incl. acute recurrent form, as well as a chronic process.

   The Center for Surgery “SM-Clinic” has introduced innovative examination methods that allow you to objectively establish this difficult diagnosis. Our otolaryngologists apply an individual approach to each patient and treat with methods that have proven effective in large-scale studies.

   As an isolated process, ethmoiditis is more common in children, and in adults it is combined with damage to other sinuses. The inflammatory reaction, as a rule, develops in the anterior cells of the ethmoid labyrinth, so inflammation can easily move to the frontal or maxillary sinus, which are located nearby. If the sinus outlet is clogged, then the pathological secret, having no outlet, can spread to the orbit, causing the development of orbital complications – an abscess, inflammation of the optic nerve, and others. Therefore, it is so important to start treatment on time.

   Currently, predominantly conservative therapy is used, and otolaryngological manipulations are carried out under endoscopic control. This ensures that the best therapeutic result is achieved.

   Species

   According to the clinical course, ethmoiditis can be of 3 forms:

   • acute – the duration of the inflammatory process does not exceed 3 months;
   • acute recurrent – the disease worsens at least 2 times a year, and a maximum of 4 times, while remission periods last at least 2 months;
   • chronic – inflammatory symptoms persist for more than 3 months.

   Symptoms

   Acute or exacerbation of chronic ethmoiditis is manifested by the following symptoms:

   • pain or pressure in the root of the nose or bridge of the nose;
   • pain in the inner corner of the orbit;
   • the presence of pathological discharge from the nasopharynx, which may be mucopurulent, purulent;
   • decreased sense of smell, up to complete absence;
   • nasal congestion.

   Terrible symptoms of ethmoiditis are:

   • eyelid edema;
   • displacement of the eyeball outwards;
   • protrusion of the eyeball;
   • eye socket pain;
   • formation of a fistula at the inner corner of the orbit.

   All these signs indicate that inflammation from the ethmoid labyrinth through the thin wall of the orbit has spread to the orbit. Sometimes there may be intracranial complications associated with a breakthrough of pus through the upper orbital wall or optic opening.

   Causes of ethmoiditis

   The leading primary factor of infection are viruses – rhino-, adeno-, respiratory syncytial viruses, influenza and parainfluenza pathogens. Due to their negative effect on the cells of the ciliated epithelium lining the upper respiratory tract, favorable conditions are created for the activation of the bacterial flora.

   In addition, the following risk factors contribute to the development of ethmoiditis, as well as the development of other sinusitis:

   • deviated nasal septum;
   • allergic inflammation of the nasal mucosa;
   • injuries, incl. barotrauma when diving to great depths;
   • smoking;
   • occupational hazards;
   • unfavorable ecological situation;
   • immunodeficiencies.

   Among bacterial agents, the inflammatory process in the ethmoid sinus most often causes pneumococcus and Haemophilus influenzae. Somewhat less frequently, microbiological identification reveals staphylococci, pyogenic streptococci. Also, anaerobic flora and atypical bacteria (chlamydia and mycoplasmas) can act as pathogens.

   Due to inflammation of the nasal mucosa and paranasal sinuses, there is a significant thickening of the tissues (edema and infiltration). Against this background, the natural fistulas of the paranasal sinuses are clogged, which leads to a violation of their drainage and ventilation function. The consequence of these processes is the stagnation of the secret in the lattice labyrinth and a change in its rheology (it becomes thick and difficult to discharge). Mucociliary transport is disturbed – these are directed movements of the cilia of the ciliated epithelium and the corresponding movement of mucus, which help to clear the airways.

   In the ethmoid sinus, the vessels expand, the permeability of the capillaries increases, which leads to an even greater increase in mucosal edema. A vicious circle is forming. If this process is not intervened in time with the help of targeted treatment, then the process extends to the deeper layers of the sinus mucosa, and in certain cases to the submucosal layer. In an acute process, all these changes are reversible; in a chronic process, it is only possible to slow down the progression, because. irreversible morphological changes develop in the form of thickening of the mucosa and the formation of polyps.

   Diagnosis of ethmoiditis

   At the initial stage, objective diagnosis is carried out using rhinoscopy. An objective diagnosis is established on the basis of endoscopic rhinoscopy.

   Computed tomography of the cribriform labyrinth may be prescribed. The method provides a higher quality of visualization of the sinuses. In acute sinusitis, fluid level, total darkening of the sinus, or thickening of the sinus mucosa by more than 5 mm is detected. In chronic ethmoiditis, against the background of parietal thickening of the mucosa, shadows of polyps can be detected.

   Patients with purulent forms of ethmoiditis may have systemic manifestations in the form of a slight rise in body temperature. In a general clinical blood test, an increase in the level of leukocytes and an acceleration of erythrocyte sedimentation are detected. The concentration of C-reactive protein may increase, especially in bacterial forms.

   Methods of treatment

   In modern otolaryngology, the treatment of ethmoiditis is carried out mainly in a conservative way. This therapy aims to achieve the following goals:

   • restoration of a normal passage between the ethmoid sinus and nasal passages for the outflow of pathological contents;
   • optimization of the functions of the ciliated epithelium;
   • elimination of pathogen and/or causative factor.

   Surgical treatment is carried out, as a rule, to correct existing developmental anomalies and acquired conditions. With the help of minimally invasive interventions, mucosal polyps, pathological bullae, irregularities of the nasal septum, etc. are eliminated.

   Conservative treatment

   To stop an acute inflammatory process in the cribriform labyrinth, drug therapy is carried out, which is individually tailored for each patient. It may include drugs from the following groups:

   • antibacterial and antiviral, which are aimed at suppressing the activity of the causative agent;
   • corticosteroids that relieve swelling and stop inflammation, which ultimately restores the normal passage of secretions between the paranasal sinuses and nasal passages;
   • vasoconstrictors that further reduce swelling;
   • mucolytics, converting a thick pathological secret into a more liquid one.

   At the stage of recovery, physiotherapy is included in the treatment program.

   Surgical treatment

   Surgical treatment is carried out in case of ineffectiveness of correctly selected drug therapy or in the presence of polyps. In the “SM-Clinic” surgical interventions are minimally invasive and are carried out under video control. This allows you to radically remove pathologically altered tissues and not affect healthy ones. This approach is the most gentle and most effective, which contributes to a quick recovery.

   Prophylaxis

   Timely treatment of inflammatory processes of the upper respiratory system will help protect against the development of ethmoiditis. If you notice that a runny nose persists for more than 7 days, be sure to consult an otolaryngologist. This may be a sign indicating the generalization of the inflammatory process and its transition to the paranasal sinuses. To protect yourself from ethmoiditis, it is also important to eliminate risk factors – treat carious teeth, resolve the issue of surgical removal of nasal polyps, correction of the nasal septum, etc. During the cold season, it is important to wash your hands regularly, avoid touching your eyes, mouth and nose, so as not to become infected with viruses that are constantly present in the air.

   Medical expert opinion

   Rehabilitation

   Special measures of rehabilitation after treatment of the inflammatory process in the cribriform labyrinth are not required. Otolaryngologists advise to regularly carry out hygiene procedures (washing the nasal passages), refrain from intensive training in the gym and not visit baths, saunas and open water. Restrictive measures are introduced for up to 10-15 days in order to create optimal conditions for the restoration of the mucosa.

   Question and answer

   Diagnosis and treatment by an otorhinolaryngologist.

   Inflammation of the ethmoid sinuses is manifested by difficulty in nasal breathing, which is combined with pain in the bridge of the nose and at the inner corner of the eye, the presence of pathological discharge from the nasal cavity and reduced sense of smell. If such symptoms occur, then it is worth visiting an otorhinolaryngologist for the timely diagnosis of the inflammatory process and the prevention of complications.