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Inflammation of the Orbit

(Inflammatory Orbital Pseudotumor)

by James Garrity, MD

Any or all of the structures within the orbit may become inflamed because of a bodywide inflammatory disorder or an inflammatory disorder that affects only the eye.

People of all ages can be affected. Inflammation can be brief or long lasting and can recur.

Causes

Inflammation of the orbit can be the result of a bodywide (systemic) inflammatory disorder. Sometimes the inflammation affects only the eye.

Systemic inflammatory disorders that affect the eye include granulomatosis with polyangiitis (formerly known as Wegener granulomatosis), in which there is generalized inflammation of blood vessels (called vasculitis—see Granulomatosis with Polyangiitis).

Inflammatory disorders that affect only the eye include scleritis, in which the white coat of the eye (sclera) becomes inflamed. Eyelid disorders with inflammation are discussed elsewhere (see Eyelid and Tearing Disorders). Inflammation affecting the tear (lacrimal) gland, located at the upper outer edge of the orbit (see Figure: Where Tears Come From), is called inflammatory dacryoadenitis. Inflammation affecting one of the muscles that move the eye is called myositis. Inflammation affecting the entire orbit and its contents is called inflammatory orbital pseudotumor (which is not really a tumor and is not a cancer) or nonspecific orbital inflammation.

Symptoms

Symptoms vary depending on which structures are actually inflamed. In general, symptoms start rather suddenly, typically over a few days. Pain and redness of the eyeball or eyelid occur. Pain can be severe and incapacitating at times. Abnormal bulging of the eyes (proptosis—bulging can also be called exophthalmos), double vision, and vision loss are also possible.

Diagnosis

Computed tomography (CT) or magnetic resonance imaging (MRI) is done. A doctor may take a sample from the inflamed area for examination under a microscope (biopsy) to determine the cause.

Treatment

Many disorders causing inflammation are treated with a corticosteroid drug, which can be given by mouth. Corticosteroids can be given by vein (intravenously) if the inflammation is severe. Radiation therapy or drugs and treatments that change the body’s immune responses (for example, methotrexate or cyclophosphamide) may sometimes be used. Less often, newer drugs (such as infliximab or rituximab) are used.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • REMICADE
  • CYTOXAN (LYOPHILIZED)
  • OTREXUP
  • RITUXAN