Copyright 2004 American Medical Association. All Rights Reserved.Applicable FARS/DFARS Restrictions Apply to Government Use.
In their excellent article on idiopathic orbital inflammatory disease,Yuen and Rubin1 describe treatment optionsfor this disorder. They point out that corticosteroids are the mainstay ofanti-inflammatory therapy for idiopathic orbital inflammation. Because thesecases are often chronic and recurring, treating physicians frequently facethe problem of balancing the benefit of steroid use with the systemic complications.We were surprised, therefore, that the authors did not comment on the useof orbital steroid injections.
Orbital steroid injections can be very useful in chronic or recurrentorbital inflammatory disease. In the orbit service at the Jules Stein EyeInstitute, Los Angeles, Calif, orbital steroid injections have been routinelyused since the 1970s to treat both Graves orbitopathy and idiopathic inflammation.In our experience, patients whose disease is controlled on 1/3 mg per kg perday of oral prednisone will often get similar relief following orbital injectionsof 32 to 40 mg/cm3 of Kenalog (triamcinolone acetonide) 40 mg/cc.The clinical response is seen within 1 or 2 days after injection. Triamcinoloneseems to have a duration of action in the orbit of approximately 1 month;without prompting, patients often volunteer that the symptoms return approximately1 month after the injection. For recurrent disease, the injections can berepeated on a monthly basis. Although the local steroid injections do noteliminate the possibility of systemic adverse effects, there is less systemicdelivery of steroid as compared with oral administration. Still, we try tolimit the frequency and number of injections; our current record is 14 injectionsin 1 patient.
The injection is given through a short 27-gauge needle, placed justinside the orbital septum. Although complications of steroid injections, includingthe risk of retinal artery embolism, have been reported,2 wehave had no sight-threatening complications during hundreds of orbital injectionsin patients with Graves orbitopathy and inflammatory disease across many decades.Unlikections, orbital injections pose a remote risk of globeinjury or prolonged elevation in intraocular pressure.
Patients with Graves orbitopathy or recurrent orbital inflammatory diseaseare justifiably discouraged about the lack of curative therapy, and everyadditional treatment option gives us more versatility in customiz-ing theirtreatment plan. Orbital steroid injections should be included on the listof potential therapeutic options for patients with idiopathic orbital inflammation.
Correspondence: Dr Goldberg, Jules Stein Eye Institute, UCLA Schoolof Medicine, 100 Stein Plaza, Los Angeles, CA 90095-7006.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Archives of Ophthalmology editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 4
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.