一名47岁男性患者因双眼复视、左眼上斜2个月就诊。既往Graves病半年。门诊检查发现双眼眼球突出、左眼上斜视、左眼下转受限，遂以“甲状腺相关眼病”收入院。入院后发现患者双眼复视、左眼上斜视呈晨轻暮重的特点，结合患者眼眶MRI结果考虑眼肌型重症肌无力，进行眼肌型重症肌无力相关检查，新斯的明试验(+)、乙酰胆碱受体抗体(+)，确诊为甲状腺相关眼病合并眼肌型重症肌无力，予溴吡斯的明联合小剂量激素治疗。治疗4个月后双眼眼位正常，双眼眼球运动正常，复视消失。
A 47-year-old man presented with binocular diplopia and hypertropia of left eye for 2 months. He was diagnosed with Graves’ disease for half a year. The patient was protruding in both eyes with hypertropia and limited of infraduction in left eye. Therefore, the patient was admitted to our ophthalmology department with the diagnosis of thyroid-associated ophthalmopathy. After admitting to hospital, binocular diplopia and left eye hypertropia grew worse by the end of the day or after exertion, and improved in the morning of the day or upon rest. Combining with the orbital MRI results, the patient was considered with ocular myasthenia gravis. The related examination of ocular myasthenia gravis was performed. The following test results were: neostigmine test (+), acetylcholine receptor antibody (+). Therefore, the patient was diagnosed with thyroid-associated ophthalmopathy combined with ocular myasthenia gravis. The patient had marked improvement after treatment with pyridostigmine and oral glucocorticoid.
患儿因“左眼红肿12 d”就诊。左上睑红肿(++++)，眼眶鼻侧可触及约黄豆大小硬结，界不清，质地中等，压痛(?)，伴上睑下垂，遮盖角膜下缘。双眼眼位正，左眼眼球外转轻度受限。眼眶及视神经MRI显示左眼上睑软组织肿胀，考虑炎性改变。入院诊断为左眼特发性眼眶炎性假瘤(Idiopathic orbital inflammatory pseudotumor，IOIP)。予以激素治疗后症状好转且随访期间无复发。本例患儿为拒绝外院活检而就诊于暨南大学附属第一医院的小儿IOIP病例，提示早期规范治疗是降低此病复发率的关键，尤其是儿童患者。
The pediatric patient was referred to our hospital with a 12-day history of left eye redness and swelling. On the orbital and nasal side of the eye, there was a firm, nontender mass about the size of soybeans, with unclear boundary, medium texture. Orbital examination showed left ptosis, covering limbus. Motility examination revealed both eyes were in normal position, and the left eye was slightly limited in extraocular rotation. Magnetic resonance imaging (MRI) revealed evidence of diffuse inflammation of left eyelid, and orbital inflammatory was considered. Excluding other etiologies, the child was diagnosed initially with idiopathic orbital inflammatory. The symptoms improved after hormone therapy and there was no recurrence during follow-up. This case was a case of IOIP in a child who was admitted to the First Affiliated Hospital of Jinan University for refusing biopsy from another hospital. The paper suggests that early standardized treatment is the key to reduce the recurrence rate of this disease, especially in children.
患儿因“左眼红肿12 d”就诊。左上睑红肿(++++)，眼眶鼻侧可触及约黄豆大小硬结，界不清，质地中等，压痛(?)，伴上睑下垂，遮盖角膜下缘。双眼眼位正，左眼眼球外转轻度受限。眼眶及视神经MRI显示左眼上睑软组织肿胀，考虑炎性改变。入院诊断为左眼特发性眼眶炎性假瘤(Idiopathic orbital inflammatory pseudotumor，IOIP)。予以激素治疗后症状好转且随访期间无复发。本例患儿为拒绝外院活检而就诊于暨南大学附属第一医院的小儿IOIP病例，提示早期规范治疗是降低此病复发率的关键，尤其是儿童患者。
The pediatric patient was referred to our hospital with a 12-day history of left eye redness and swelling. On the orbital and nasal side of the eye, there was a firm, nontender mass about the size of soybeans, with unclear boundary, medium texture. Orbital examination showed left ptosis, covering limbus. Motility examination revealed both eyes were in normal position, and the left eye was slightly limited in extraocular rotation. Magnetic resonance imaging (MRI) revealed evidence of diffuse inflammation of left eyelid, and orbital inflammatory was considered. Excluding other etiologies, the child was diagnosed initially with idiopathic orbital inflammatory. The symptoms improved after hormone therapy and there was no recurrence during follow-up. This case was a case of IOIP in a child who was admitted to the First Affiliated Hospital of Jinan University for refusing biopsy from another hospital. The paper suggests that early standardized treatment is the key to reduce the recurrence rate of this disease, especially in children.
