Merck Manual

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Inflammation of the Orbit

(Inflammatory Orbital Pseudotumor)

By

James Garrity

, MD, Mayo Clinic College of Medicine

Last full review/revision Jul 2020| Content last modified Jul 2020
Click here for the Professional Version

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/orbit include granulomatosis with polyangiitis (formerly known as Wegener granulomatosis), in which there is generalized inflammation of blood vessels (called vasculitis). Another recently described type of inflammation is called IgG4-related orbital inflammation, which can affect the same structures as granulomatosis with polyangiitis but typically has fewer symptoms.

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. Inflammation affecting any or all parts of the orbit is called inflammatory orbital pseudotumor (which is not really a tumor and is not a cancer) or nonspecific orbital inflammation. 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.

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 usually occur. Pain can be severe and incapacitating at times. Abnormal bulging of the eyes (proptosis), double vision, and vision loss are also possible. Symptoms related to IgG4-related orbital inflammation, on the other hand, are minimal. Rarely is there any discomfort, but rather proptosis and eyelid swelling are common.

Diagnosis

  • Computed tomography or magnetic resonance imaging

  • Biopsy

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

  • Drugs to treat inflammation

  • Radiation therapy or drugs to change immune response

Many disorders causing inflammation of the orbit 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 may sometimes be used. IgG4 typically responds to corticosteroids or, if necessary, other drugs to change the body's immune response.

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