Orbital Myositis in a Patient With Ileal Crohn's Disease in Remission on Vedolizumab

Orbital myositis (OM) is an extremely rare ocular extraintestinal manifestation of inflammatory bowel disease. Acute or chronic inflammation of one or more extraocular muscles leads to symptoms related to the mass effect including orbital pain, swelling, ophthalmoplegia, proptosis, and diplopia. Although the use of steroids typically leads to rapid resolution of symptoms, recurrence is common, necessitating long-term steroid-sparing therapies. Given the rare presentation of OM, its pathogenesis and optimal therapy are not well established. We present a young woman with Crohn's disease in remission on vedolizumab who developed OM, and we discuss our management approach.