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Inflammatory Orbital Disease

(Inflammatory Orbital Pseudotumor)

By James Garrity, MD, Whitney and Betty MacMillan Professor of Ophthalmology, Mayo Clinic College of Medicine

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Inflammatory orbital disease is a benign space-occupying inflammation involving orbital tissues.

Orbital inflammation (inflammatory orbital pseudotumor) can affect any or all structures within the orbit. The inflammatory response can be nonspecific, granulomatous, or vasculitic or due to reactive lymphoid hyperplasia. The inflammation can be part of an underlying medical disorder or can exist in isolation. Patients of all ages can be affected. The process can be acute or chronic and can recur.

Symptoms and Signs

Symptoms and signs typically include a sudden onset of pain along with swelling and erythema of the eyelids. Proptosis, diplopia, and vision loss are also possible. In cases of reactive lymphoid hyperplasia, there are typically few symptoms other than proptosis or swelling.


  • CT or MRI

Similar findings occur with orbital infection (see Preseptal and Orbital Cellulitis), but there is no history of trauma or adjacent focus of infection (eg, sinusitis). Neuroimaging with CT or MRI is required. For chronic or recurrent disease, biopsy may be used to find evidence of an underlying medical condition.


Treatment depends on the type of inflammatory response and may include oral corticosteroids, radiation therapy, and one of several immunomodulating drugs. In difficult cases, some initial success has occurred with monoclonal antibodies against TNF-alphaor with another monoclonal antibody that causes lymphocyte depletion.