A síndrome de Tolosa-Hunt manifesta-se como oftalmoplegia dolorosa. A corticoterapia é o tratamento de primeira linha estabelecido, mas um subgrupo de pacientes não obtém a resposta esperada — necessitando de um protocolo de segunda linha definido.
A corticoterapia de primeira linha — metilprednisolona, prednisolona ou dexametasona, administrada por via oral ou intravenosa — é considerada falha quando não alcança a resolução da dor orbitária e periorbital e da oftalmoplegia (paresia) em 48 horas. Nesse momento, a escalada para este protocolo está indicada.
DOI: 10.4236/ym.2020.42014
Infusion with 300 mg of a tumor necrosis factor-alpha antibody (infliximab) has been reported to result into dramatic and tenacious recovery in patients who previously reported recurrence of headache and diplopia on tapering prednisone to beneath 50 mg and cushingoid hallmarks, edematous legs, acne and hyperglycemia on maintanance 50 mg daily, hence, controlled researches should be conducted to systematize the usage of infliximab in THS, other alternative therapies include azathioprine and methotrexate which irregularly demands to be supplemented to sustain the primary response to glucocorticoids.
Nonetheless, acupuncture has been widely utilized for management of ophthalmological conditions particularly ophthalmoplegia in China, Multiple clinical trials show that acupuncture may improve the recovery of extra-ocular muscles in ophthalmoplegia cases farther researches are warranted to appraise the effectiveness and safety of acupuncture for THS ophthalmoplegia.
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