title: Idiopathic orbital inflammatory syndrome without pain: a case report.
abstract: BACKGROUND
  Idiopathic orbital inflammatory syndrome (IOIS) is a collection of primary orbital inflammatory expressions manifested in a variety of clinical presentations. Because the process is idiopathic, it lacks association with neoplastic, infectious, or systemic immunologic and inflammatory diseases. Therefore, an extensive analysis is required to exclude secondary etiologies of orbital inflammation.
  
  
  METHODS
  Exhibited is a case of a 68-year-old white man presenting with a recent history of viral conjunctivitis and acute complaints of monocular vision loss, epiphora, photophobia, and generalized irritation without pain. On examination, he was found to have chemosis, a serous retinal detachment, and choroidal detachments. Magnetic resonance imaging found evidence of dacryoadenitis, posterior scleritis, and mild diffuse orbital inflammation. Extensive history and physical examination found no evidence of systemic inflammatory disease. IOIS was diagnosed and treated successfully with prednisone, without recurrence.
  
  
  CONCLUSIONS
  Pain is historically considered a cardinal sign of acute inflammation and a predominant symptom of IOIS. The authors present a case of acute IOIS, atypical because of its presentation in the absence of pain. In addition, a review of the literature is conducted to identify predominant clinical and radiologic characteristics of IOIS along with current accepted and proposed treatment options. Differentials are discussed to distinguish this disease from systemic immunologic and inflammatory conditions such as syphilis, sarcoidosis, and Wegener's granulomatosis as well as potentially fatal neoplastic conditions.
authors.affiliation: Salem Veterans Affairs Medical Center, 1970 Roanoke Blvd., Salem, VA 24153, USA. scott.slagle@va.gov
authors.forename: William Scott
authors.initials: WS
authors.lastname: Slagle
authors.forename: Kari H
authors.initials: KH
authors.lastname: Boothe
authors.forename: Angela N
authors.initials: AN
authors.lastname: Musick
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Eckermann
authors.forename: Amber M
authors.initials: AM
authors.lastname: Slagle
mesh_terms: D000368:Aged; D003229:Conjunctival Diseases / Q000150:complications; D003607:Dacryocystitis / Q000150:complications; D003937:Diagnosis, Differential; D004487:Edema / Q000150:complications; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D009916:Orbital Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D010146:Pain / Q000503:physiopathology*; D011241:Prednisone / Q000627:therapeutic use; D015423:Scleritis / Q000150:complications; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D011241:Prednisone