Trochleitis is a cause of periorbital pain that may be perceived as a headache.

Trochleitis is inflammation of the trochlea and peritrochlear tissue (superior oblique muscle, sheath of the superior oblique muscle, tendon of the superior oblique muscle, etc).


Conditions associated with trochleitis include:

(1) SLE

(2) adult-onset Still's disease

(3) Wegener's granulomatosis

(4) rheumatoid arthritis

(5) juvenile idiopathic arthritis


It may be unilateral or bilateral.


Clinical features:

(1) orbital pain described as dull, aching or stabbing

(2) pain made worse by eye movement, especially with upgaze

(3) ocular movement may be restricted in adduction and downgaze

(4) tenderness on palpation of the trochlear region

(5) variable orbital swelling

(6) occasional association with migraine headache


The patient may complain of pain while trying to read.


Imaging studies show inflammation with swelling in the trochlear complex.

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