Etiology and management of idiopathic orbital inflammation

Abstract

Inflammatory disease is commonly encountered by the ophthalmologist and spans the spectrum from intraocular inflammations (uveitis) to any component of the orbit. Extraocular orbital and adnexal inflammation with no identifiable local or systemic cause is often referred to as orbital pseudotumor or idiopathic orbital inflammation (IOI). When initially described over a century ago, 1 Gleason J. Idiopathic myositis involving the intraocular muscles. Ophthalmol Rec. 1903; 12: 471-478 Google Scholar most conditions defied pathophysiologic explanation. Although exponential advances in medicine have unlocked many mysteries, IOI remains the third most common orbital disease following thyroid associated orbitopathy and lymphopoliferative disease, accounting for approximately 5% of orbital disorders 2 Henderson J. Orbital tumors. Thieme-Stratton, New York1980 Google Scholar and tied for the most commonly biopsied orbital lesion in one large series. 3 Shields J.A. Shields C.L. Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions The 2002 Montgomery Lecture, part 1. Ophthalmology. 2004; 111: 997-1008 Abstract Full Text Full Text PDF PubMed Scopus (705) Google Scholar It remains a diagnosis of exclusion and is characterized by its chronicity, anatomic location, or histologic subtype. Putatively, this condition represents an autoimmune reaction to orbital tissues in response to an unknown immunologic trigger. In this month’s journal, a novel treatment modality has been suggested for management of recalcitrant inflammation. 4 Garrity J. Coleman A. Matteson E. Eggenberger E. Waitzman D. Treatment of recalcitrant idiopathic orbital inflammation (chronic orbital myositis) with infliximab. Am J Ophthalmol. 2004; 138: 925-930 Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar