Clinical Characteristics, Treatment, and Outcome of Trochleitis

Abstract

Background and purpose: To study the clinical characteristics, treatment options, and outcome of patients with trochleitis in our population.

Methods: Retrospective review of 59 patients diagnosed with trochleitis in the Ramon y Cajal Hospital Emergency Service between 2003 and 2010. Demographic data and trochleitis features were described. The relationship between outcome and treatment options was analyzed by SPSS.

Results: The estimated prevalence rate of trochleitis in our area was 12 per 100,000. The average age of patients was 43±18 years. The majority of cases were women (86%). One case was bilateral. Patients' chief complaints were continuous pain (66%), pain only with ocular movements (25%), or pain only with palpation (8%). Ocular movement limitations were presented in 14%. Diplopia was observed in 12%, and 19% complained of headache. Oral non-steroidal anti-inflammatory drugs (NSAIDs) were the first option for treatment in 85% of cases, associated with oral steroids in 8% of patients. Oral steroids were the first and only option for treatment in 3%. Symptoms completely resolved in 80%, with the worst responses seen in cases with motility disturbances. Peritrochlear triamcinolone acetonide was injected in 14% of cases, achieving a good response in 62%.

Conclusions: The prevalence of trochleitis in our area is low, and this pathology is more frequent in females. Oral NSAIDs are efficient to resolve isolated pain, but the response is partial if diplopia or motility limitations are associated. Some non-responders achieved good results with peritrochlear triamcinolone. Successful management provides a good prognosis for most patients.

Keywords: Brown syndrome; headache; primary trochlear headache; trochlear inflammation; trochleitis.