Q. Please have a look over MRI and suggest that the fibrotic is still visible on the MRI.
Hello doctor, Pain after idiopathic orbital inflammation before 11 years. I have undergone biopt two times due to inflammation with fibrosis and sclerosis. Now the doctors say the disease is gone. But I am still in pain and again using 15 mg Prednisone a day. They told me I have neuropathic pain, and this is more often in other patients with pseudotumor orbitae. My question is, can fibrotic tissue that is still visible on the MRI, cause the pain? Is there inflammation seen on the MRI? Or abnormalities or myositis?
Hello. I saw the MRI (attachment removed to protect patient identity), the sclerotic tissue from which we have to confirm that the pain you are experiencing is mainly neuropathic and emerging not from the sclerotic tissues as much as from the adjacent structures that are rich with nerves and blood vessels. Due to the anatomic changes that the eye has gone through, all the adjacent structures are still adapting to those newly acquired conditions, and that is what most probably is causing the pain. Whether it is from the compression or the disturbance in blood supply, currently, there is not much to do but to keep reducing the inflammation and prevent future reoccurrence with the prednisolone, but specific preventive measures such as undergoing a comprehensive eye exam as per the ophthalmologist recommendations are necessary. That examination should include tonometry - intraocular pressure, perimetry-visual fields, and optical coherence tomography to exclude any newly acquired changes that might require intervention. As for the diagnosis, although not much changes to the treatment will take place, it should be enforced with a blood test called ANA (antinuclear antibodies) profile to exclude any autoimmune disease that might develop on other organs. I would add a course of Neurobion, which is a complex of vitamins group B and might want to consult a physiotherapist on a method to improve blood circulation in the affected area. I hope I have cleared a few of your questions, and please feel free to follow up with additional inquiries or test results.