Trochleitis is inflammation of the superior oblique tendon trochlea apparatus characterized by localized swelling, tenderness, and severe pain. This condition is an uncommon but treatable cause of periorbital pain. The trochlea is a ring-like apparatus of cartilage through which passes the tendon of the superior oblique muscle. It is located in the superior nasal orbit and functions as a pulley for the superior oblique muscle.
Inflammation of the trochlear region leads to a painful syndrome with swelling and exquisite point tenderness in the upper medial rim of the orbit. A vicious cycle may ensue such that inflammation causes swelling and fraying of the tendon which then increases the friction of passing through the trochlea which in turn adds to the inflammation. Trochleitis has also been associated with triggering or worsening of migraine attacks in patients with pre-existing migraines.
Trochleitis is diagnosed according to these 3 criteria:
1. demonstration of inflammation of superior oblique tendon/ trochlea region;
2. periorbital pain and tenderness to palpation in the area of the sore trochlea, and
3. Worsening of pain on attempted vertical eye movement, particularly with adduction of the eye.
You should consult an ophthalmologist to check if you are fulfilling all those 3 criteria.
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