Merck Manual

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Inflammation of the Orbit

(Inflammatory Orbital Pseudotumor)


Richard C. Allen

, MD, PhD, University of Texas at Austin Dell Medical School

Reviewed/Revised Oct 2022

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

People of all ages can be affected. Inflammation can be brief or long lasting, may or may not be caused by an infection, and can recur.

Causes of Orbital Inflammation

Inflammation of the orbit can be the result of a bodywide (systemic) inflammatory disorder. Sometimes the inflammation affects only the orbit. Inflammation can be caused by infection or by a noninfectious disorder. Inflammation of the orbit due to infection that affects the eyelid, skin, and tissues around the front of the eye is called preseptal cellulitis Preseptal Cellulitis Preseptal cellulitis is infection of the eyelid and of the skin and tissues around the front of the eye. (See also Introduction to Eye Socket Disorders.) Both preseptal cellulitis and orbital... read more Preseptal Cellulitis . Inflammation that affects the tissue within the orbit and around and behind the eye is called orbital cellulitis Orbital Cellulitis Orbital cellulitis is infection affecting the tissue within the orbit and around and behind the eye. Infection can spread to the orbit from sources such as the sinuses around the nose. Symptoms... read more Orbital Cellulitis . Noninfectious orbital inflammation has many causes. The most common cause of noninfectious inflammation of the eye socket is thyroid eye disease (also known as Graves ophthalmopathy Graves disease Hyperthyroidism is overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions. Graves disease is the most common cause of hyperthyroidism... read more Graves disease ).

Inflammatory disorders that affect only the eye include scleritis Scleritis Scleritis is severe, destructive inflammation of the sclera (the tough, white, fiber layer covering the eye) that may threaten vision. Scleritis sometimes occurs in people who have a bodywide... read more , in which the white coat of the eye (sclera) becomes inflamed. Eyelid disorders Eyelid and Tearing 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 ), is called dacryoadenitis. Inflammation affecting one of the muscles that move the eye is called myositis.

Symptoms of Orbital Inflammation

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 Bulging Eyes Bulging or protruding of one or both eyes is called proptosis or exophthalmos. Exophthalmos is usually used when describing bulging eyes caused by Graves disease, a disorder causing overactivity... read more Bulging Eyes ), double vision, and vision loss are also possible. Symptoms related to IgG4-related orbital inflammation, on the other hand, are usually minimal. Rarely is there any discomfort, but rather proptosis and eyelid swelling Eyelid Swelling A person may experience swelling in one or both eyelids. Swelling may be painless or accompanied by itching or pain. Eyelid swelling is distinct from bulging eyes, although a few disorders can... read more are common. Other symptoms depend upon the disorder causing the orbital inflammation.

Diagnosis of Orbital Inflammation

Treatment of Orbital Inflammation

  • Drugs to treat inflammation (corticosteroids)

  • Radiation therapy or drugs to change immune response and treat the underlying cause

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 (for example, rituximab).

Sometimes surgery is needed to help resolve or prevent progression of thyroid eye disease.

Drugs Mentioned In This Article

Generic Name Select Brand Names
RIABNI, Rituxan, RUXIENCE, truxima
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