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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