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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.

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 of inflammatory orbital pseudotumor 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.

Diagnosis

  • CT or MRI

Similar findings occur with inflammatory orbital pseudotumor and orbital infection, but there is no history of trauma or adjacent focus of infection (eg, sinusitis) with inflammatory orbital pseudotumor. 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

  • Corticosteroids, radiation therapy, and/or immunomodulating drugs

Treatment for inflammatory orbital pseudotumor depends on the type of inflammatory response and may include oral corticosteroids, radiation therapy, and one of several immunomodulating drugs. In difficult cases of inflammatory orbital pseudotumor, particularly those with granulomatous inflammation, some initial success has occurred with monoclonal antibodies against TNF-alpha or with lymphocyte depletion using rituximab, if the inflammation is primarily vasculitis.

Drugs Mentioned In This Article

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  • RITUXAN