Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of autoimmune disorders that cause inflammation and necrosis of small- to medium-sized blood vessels. It most commonly affects the kidneys and lungs, leading to complications such as rapidly progressive glomerulonephritis and pulmonary hemorrhage. (1) Ocular involvement occurs in up to 50% of patients with AAV, most commonly presenting as scleritis, episcleritis, or orbital inflammatory disease (also known as orbital pseudotumor). Other ocular findings may include keratitis, uveitis, or retinal vasculitis. (2)(3) Eyelid necrosis with destructive orbital inflammation, however, is extremely rare and poses a significant diagnostic challenge because its presentation can mimic infections, malignancies, or other inflammatory orbital conditions. Prompt recognition is critical to prevent irreversible tissue damage and vision loss. (4) We report the case of a 74-year-old Hispanic woman with multiple vascular risk factors who presented with recurrent pustules of the right upper eyelid that progressed to full-thickness eyelid necrosis, medial orbital mass effect, and corneal compromise. Initial management was directed toward presumed orbital cellulitis; however, orbital imaging revealed a destructive extraconal mass with mass effect and associated venous stasis. Sequential biopsies demonstrated extensive necrosis with histiocytoid granulomatous inflammation and focal features of chronic vasculitis. Negative stains and cultures excluded infectious and neoplastic causes. After thorough evaluation and exclusion of alternative etiologies, the findings were most consistent with ANCA-negative ANCA-associated vasculitis (AAV). The patient was treated with high-dose intravenous corticosteroids and rituximab induction, resulting in stabilization of orbital disease and preservation of vision. This case highlights the potential for destructive orbital vasculitis to masquerade as infection or malignancy and underscores the importance of considering AAV in atypical orbital presentations. Prompt recognition and initiation of immunosuppressive therapy are critical to prevent irreversible morbidity.

To characterise the clinical, radiological and histopathological features of biopsied lacrimal glands in a Japanese population and to identify clinical parameters that may assist in differential diagnosis. This retrospective review included consecutive patients who underwent incisional lacrimal gland biopsy between January 2016 and August 2025 at a tertiary referral centre in Japan. Clinical, imaging and laboratory data, along with histopathologic diagnoses, were analysed. Lacrimal gland dimensions were measured on orbital images and comparative statistical analyses were performed among major diagnostic groups. A total of 128 patients were included. The most frequent diagnosis was immunoglobulin G4-related ophthalmic disease (IgG4-ROD, 44.5%), followed by idiopathic orbital inflammation (IOI, 25.7%), lymphoproliferative disorders (20.3%) and other specific inflammatory dacryoadenitis (9.3%). IgG4-ROD and lymphoma showed significantly higher rates of systemic involvement compared with IOI (P = 0.015) and bilateral disease was more common in IgG4-ROD (P = 0.010). Lacrimal gland size tended to be larger in lymphoma and IgG4-ROD. Of 58 bilateral cases biopsied on both sides, 57 showed identical histopathologic findings. IgG4-ROD was the leading cause of lacrimal gland enlargement in this Japanese cohort, suggesting a higher prevalence than in other populations. Integrating clinical factors such as age, laterality and systemic involvement enhances diagnostic accuracy. Unilateral biopsy is generally sufficient in bilateral cases.

Patient: Male, 77-year-oldFinal Diagnosis: Panophthalmitis with orbital cellulitisSymptoms: Severe ocular pain • eyelid swelling • restricted ocular motility • marked reduction in visual acuityClinical Procedure: —Specialty: OphthalmologyObjective: Management of emergency careBackgroundGlaucoma drainage implants, including the Paul glaucoma implant, are widely used in the management of refractory glaucoma when medical therapy and conventional filtering surgery prove insufficient. Although associated with favorable outcomes, rare but serious postoperative complications such as endophthalmitis and panophthalmitis can occur, resulting in significant visual morbidity.Case ReportWe describe the case of a 77-year-old man with chronic angle-closure glaucoma who developed acute panophthalmitis with orbital cellulitis 12 days following uneventful Paul glaucoma implant surgery. He presented with severe ocular pain, eyelid swelling, restricted ocular motility, and marked reduction in visual acuity to light perception. Clinical examination revealed pronounced anterior and posterior segment inflammation. B-scan ultrasonography showed dense vitreous opacities, shallow choroidal detachment, and ocular wall thickening. Computed tomography of the orbit confirmed associated orbital cellulitis with proptosis and extraocular muscle swelling. The patient underwent vitreous tap with intravitreal vancomycin, ceftazidime, and dexamethasone, along with intensive topical and systemic antimicrobial therapy. Despite an initial partial response, progressive inflammation required pars plana vitrectomy. Removal of the glaucoma drainage implant was not possible intraoperatively due to severe inflammation. Microbiological cultures remained negative throughout. With coordinated multidisciplinary management involving glaucoma, retina, and oculoplastic services, orbital inflammation gradually resolved, and visual acuity improved from light perception to 20/250 at final follow-up.ConclusionsThis case highlights the importance of close postoperative monitoring to ensure correct diagnosis and aggressive management of infections, preservation of globe integrity, and optimization of visual outcomes following glaucoma drainage device surgery.

Extra-intestinal manifestations of inflammatory bowel disease (IBD) occur in 25-40% of patients; however, orbital involvement is rare and underreported. Only case reports and series have been documented in the literature with no consensus on diagnosis or management. This systematic review aims to compile and analyse the published literature on orbital manifestations of IBD, focusing on clinical presentation, imaging, management and outcomes. A systematic search of PubMed, Embase, and Web of Science was performed from database inception to April 2025. Data were collected and risk of bias was assessed using the JBI Critical Appraisal Checklist for Case Reports/Case Series. 41 studies reporting 48 patients were included. Mean age at orbital presentation was 31 years (range 2-63 years) with a female predominance (3:1). Orbital inflammation preceded IBD diagnosis in 19 patients. Crohn's disease was most frequently associated (n = 40). The most common clinical features were periorbital pain, swelling and ophthalmoplegia, with orbital myositis (n = 32) and dacryoadenitis (n = 15) being the predominant manifestations. 30 of 48 cases (63%) presented with bilateral disease, in contrast to the 8-20% bilateral rate typically reported for non-specific orbital inflammation (NSOI). Imaging most often demonstrated extraocular muscle enlargement. The majority of patients received systemic corticosteroids, often in combination with immunomodulators or biologics with most achieving remission. Recurrence occurred in 22 patients, and two experienced permanent vision loss. Orbital IBD is a rare but clinically significant entity, and may precede intestinal symptoms, sometimes representing the first sign of underlying IBD. Clinicians should maintain vigilance for orbital involvement in IBD, and standardised prospective reporting is needed to better characterise these manifestations and optimise patient outcomes.

PurposeTo report a retrospective tertiary-center series of unilateral orbital lesions and to illustrate a structured, experience-based multidisciplinary workflow integrating clinical, radiologic, and histopathologic data to support differential diagnosis and management in real-world practice.Patients and MethodsThis retrospective descriptive case-series included 18 patients with biopsy-confirmed unilateral orbital lesions evaluated between January 2021 and March 2025 at the Oculoplastic and Orbital Surgery Unit, Humanitas Research Hospital, Milan. Demographic, clinical, imaging, and histopathologic data were analyzed. Imaging included computed tomography (CT), magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), and functional techniques such as MRA, PET/CT when indicated. Histopathology incorporated immunohistochemistry (IHC) and proliferative indices (Ki-67). Outcomes included final diagnosis, treatment, and early recurrence.Results18 patients were included: dermoid cysts (n = 3), vascular malformations (n = 6), neurofibroma (n = 1), idiopathic orbital inflammation (n = 2), meningioma (n = 1), and epithelial malignancies (adenoid cystic carcinoma, basal cell carcinoma, squamous cell carcinoma, mucinous carcinoma, Merkel cell carcinoma; n = 5). Characteristic MRI and IHC patterns enabled accurate subclassification and guided informed-individualized management decisions, ranging from observation or image-guided sclerotherapy to complete surgical excision or multidisciplinary oncologic therapy. No recurrence occurred among benign lesions. Malignant epithelial tumors required adjuvant radiotherapy or systemic therapy according to histologic subtype and TNM stage.ConclusionA systematic, multidisciplinary approach integrating cross-sectional imaging and histopathologic assessment underpins effective diagnostic and therapeutic decision-making in unilateral orbital disease. The proposed workflow, derived from institutional practice, offers an illustrative and reproducible framework for clinical reasoning and therapeutic decision-making based on real case scenarios. Its adaptability lies in the use of structured clinical–radiologic algorithms, which may help optimize individualized management, facilitate timely referral, and reduce unnecessary invasive procedures, particularly within tertiary referral settings.

Uveal effusion syndrome associated with diffuse idiopathic orbital inflammation (IOI)

Plasma-derived exosomes from Graves' orbitopathy: Pathogenic entities causing tissue lesions.

Эндокринная офтальмопатия (ЭОП) — это самостоятельное прогрессирующее аутоиммунное заболевание органа зрения, чаще всего ассоциированное с болезнью Грейвса. Несмотря на то, что ритуксимаб применяется off-label при активной стероидорезистентной ЭОП, описаны случаи парадоксальной активации аутоиммунных процессов на фоне его применения. Мы представляем редкий случай манифестации ЭОП после химиотерапии бендамустином и ритуксимабом (BR) по поводу хронического лимфолейкоза (ХЛЛ). У 73-летнего мужчины с 3-летним анамнезом болезни Грейвса через 2 недели после второго цикла BR-химиотерапии появились двусторонний экзофтальм, диплопия и снижение остроты зрения. Пациент не курил, радиойодтерапия не проводилась. При обследовании обнаружены высокие уровни антител к рецептору ТТГ, утолщение глазодвигательных мышц по данным МРТ орбит. Диагностирована активная фаза (CAS 6/6) среднетяжелой ЭОП (EUGOGO). Несмотря на два курса пульс-терапии метилпреднизолоном (суммарная доза — 12,2 г) и 10 ретробульбарных инъекций дексаметазона, заболевание прогрессировало до тяжелой степени, осложненной оптической нейропатией со снижением зрительных функций. Хотя у пациента была предрасположенность к аутоиммунным нарушениям, тесная временная связь с BR-терапией, быстрое прогрессирование и резистентность к глюкокортикоидам указывают на значимую роль химиотерапии в нарушении иммунного гомеостаза. Ритуксимаб-индуцированная деплеция В-клеток и синдром высвобождения цитокинов могли способствовать Т-клеточному воспалению в орбите, а бендамустин — усугубить состояние за счет лимфопении и нарушения иммунной толерантности. Данный клинический случай иллюстрирует потенциальную парадоксальную активацию аутоиммунного заболевания после BR-химиотерапии у предрасположенного пациента. Это определяет необходимость скрининга пациентов с сопутствующим аутоиммунным заболеванием щитовидной железы на наличие ЭОП до, во время и после BR-химиотерапии по поводу ХЛЛ. Необходимы дальнейшие исследования для верификации данного феномена.

Assessing periocular inflammation is essential in several disorders, including Thyroid Eye Disease (TED). The Clinical Activity Score (CAS) is the most commonly used method to assess orbital inflammation, but is associated with significant inter-observer variability. The aim of this study was to assess the ability of Infrared Thermography (IRT) to detect orbital inflammation in TED and other orbital inflammation disorders (OOID). A retrospective study was conducted between March 2020 and November 2023. Patients were divided into four groups: active TED (CAS ≥ 3), non-active TED (CAS < 3), OOID, and healthy controls. Demographics, proptosis, and CAS were recorded. IRT was performed in 6 periocular areas, including the caruncle. Four IRT periocular patterns were characterized. Hundred and ten patients (63.64% of women) with a mean age of 59.47 (25-93) years were included. Thirteen (11.82%) patients were included in the active TED group, 44 (40.00%) in the non-active TED group, 17 (15.45%) in the OOID group and 36 (32.73%) in the control group. Non-active TED and control patients had lower mean caruncular and periocular temperatures compared to active TED and OOID patients (p < 0.05). The caruncular temperature was significantly higher in active TED patients compared to OOID patients (p < 0.05). Non-active TED and control patients mainly showed round and upper coma IRT patterns while active TED and OOID patients showed crab claw and other IRT patterns (p < 0.05). Periocular IRT measurement is a rapid, simple, non-invasive, cost-effective, and reproducible method for detecting orbital inflammation and allows differentiating active TED from OOID.

There is a need for measures of disease severity for giant cell arteritis (GCA), which may enable identification of high-risk subgroups (eg, ophthalmic complications) and individualized approaches to therapy. We derived a continuous score using data from cranial vessel wall magnetic resonance imaging (VW-MRI) to quantify vascular burden in GCA and assessed the score's association with ophthalmic manifestations. Patients with suspected new or relapsing GCA underwent cranial VW-MRI plus dedicated orbital MRI. A radiologist assessed VW-MRI enhancement of seven cranial structures bilaterally. Using a generalized linear mixed-effects model, a continuous MRI-derived patient-level score (range 1-10) of disease extent was developed: the Cranial Artery MRI Score for GCA (CAMRIS-GCA). CAMRIS-GCA was compared between clinical diagnosis (ocular GCA, nonocular GCA, or non-GCA) and patients with versus without ocular inflammation on MRI (defined as ophthalmic artery or optic nerve sheath enhancement). Seventy-four patients (17 ocular GCA, 16 nonocular GCA, and 41 non-GCA) were included. CAMRIS-GCA increased linearly across clinically defined groups of non-GCA, nonocular GCA, and ocular GCA (CAMRIS-GCA median 0.6 [interquartile range (IQR) 0-1.7] vs median 2.5 [IQR 0.5-6.6] vs median 4.8 [IQR 2.1-8.5]; P < 0.01). Patients with orbital inflammation on MRI (with or without visual symptoms) had a higher median CAMRIS-GCA compared to patients with negative orbital MRI (median 6.7 [IQR 5.6-8.5] vs median 0.4 [IQR 0-1.6]; P < 0.01). This proof-of-concept study introduces a quantitative MRI-derived vascular burden score in GCA and demonstrates its association with ophthalmic involvement. These early findings suggest that cranial VW-MRI may offer a prognostic value in identifying patients at risk for vision-threatening disease.

Non-specific orbital inflammation (NSOI), formerly known as idiopathic orbital inflammatory disease (IOID), is a rare, exclusion-based orbital disorder with diverse clinical manifestations. This study evaluates the demographic patterns, clinical features, histopathological profiles, and treatment outcomes of NSOI cases managed at a tertiary referral centre in Malaysia. A six-year retrospective review was conducted at a tertiary referral centre in northern Malaysia, involving 36 patients diagnosed with NSOI between January 2018 and December 2023. Diagnosis was based on clinical features, exclusion of systemic and infectious causes through serology, and supportive imaging or biopsy findings. Only cases with histopathological confirmation and immunohistochemical staining negative for lymphoma, carcinoma, and other malignancies were included. Data included demographics, clinical presentation, imaging and histopathological findings, serologic evaluations, and treatment modalities. Outcomes were assessed based on symptom resolution, radiologic improvement, recurrence, and treatment response. Most patients were male (61.1%), with a mean age of 43.6 years. Unilateral involvement predominated (77.8%). Common presentations included periorbital swelling (69.4%), ophthalmoplegia (22.2%), conjunctival mass (22.2%), and proptosis (19.4%). Imaging revealed frequent involvement of the lacrimal gland (45.8%), extraocular muscles (37.5%), and conjunctiva (37.5%). The main histopathological findings included reactive lymphoid hyperplasia (40%), granulomatous inflammation (20%), and chronic inflammation (23.3%). Of the 36 patients, 19 received medical treatment, with 84.2% given systemic corticosteroids, while the remaining 17 patients were managed conservatively without any medical treatment, and they remained clinically stable throughout follow-up with no evidence of disease progression. Among treated cases, recurrence occurred in 25%, predominantly in males. NSOI shows varied clinical and anatomical patterns. Corticosteroids remain the mainstay of treatment, but conservative management is appropriate in stable, nonprogressive cases when close monitoring and diagnostic exclusion are assured. These findings support individualised therapeutic strategies and long-term followup.

BackgroundEosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a rare antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis characterized by asthma, eosinophilia, and systemic vasculitis. Ocular involvement is uncommon (6–20%) and usually follows systemic disease. In contrast, granulomatosis with polyangiitis (GPA) more frequently (30–60%) involves the orbit and may present as isolated orbital disease. Distinguishing EGPA from GPA can therefore be challenging when orbital inflammation is the initial manifestation, particularly in children.Case presentationA 7-year-old girl was referred with unilateral orbital swelling that was initially treated as preseptal cellulitis with oral amoxicillin and topical ciprofloxacin, without clinical improvement. Examination revealed a firm, mobile, tender superotemporal orbital mass with restricted upgaze, while visual acuity and fundus examination were normal. Orbital magnetic resonance imaging demonstrated an extraconal lesion exerting mass effect on the superior rectus muscle, globe, and lacrimal gland. The lesion was isointense on T1-weighted images, hyperintense on T2-weighted images, and showed marked contrast enhancement without diffusion restriction. Orbital biopsy revealed dense eosinophilic infiltration with granuloma formation and perivascular inflammation. Serologic testing demonstrated positive perinuclear (P-) ANCA with elevated myeloperoxidase (MPO) antibodies, supporting a diagnosis within the spectrum of ANCA-associated vasculitis. Systemic evaluation revealed no other inflammatory lesions, apart from bilateral otitis media with effusion. The patient underwent surgical debulking, which relieved the mass effect and provided diagnostic tissue. Subsequent treatment with high-dose systemic corticosteroids and rituximab resulted in clinical improvement with sustained systemic clinical and biochemical remission. Follow-up MRI, however, showed no significant reduction in the size of the orbital mass, necessitating a second, more extensive surgical debulking.ConclusionIsolated orbital inflammation may represent an initial manifestation of ANCA-associated vasculitis in pediatric patients. Although eosinophil-rich granulomatous inflammation and MPO-ANCA positivity may suggest eosinophilic granulomatosis with polyangiitis, predominant orbital and ENT involvement in the absence of asthma or other atopic features may be more consistent with localized granulomatosis with polyangiitis. This case underscores the importance of early orbital biopsy, comprehensive serological evaluation, and cautious interpretation of residual orbital lesions within a multidisciplinary, longitudinal diagnostic approach.

Thyroid eye disease (TED) is an autoimmune inflammatory disorder primarily affecting orbital tissues, but ocular surface and adnexal involvement represent a frequent and clinically significant component of disease burden. Beyond mechanical exposure resulting from eyelid retraction and proptosis, TED-associated ocular surface disease arises from complex interactions between immune activation, epithelial stress, glandular dysfunction, and altered neuro-epithelial signaling. Increasing use of systemic immunomodulatory therapies, biologics, and orbital radiotherapy has improved control of orbital inflammation; however, their molecular and cellular effects on ocular surface homeostasis remain incompletely defined. This review summarizes current evidence on the cellular and molecular mechanisms underlying ocular surface dysfunction in TED and examines how disease-modifying therapies influence epithelial integrity, tear film stability, meibomian and lacrimal gland function, and local immune signaling. Key pathways discussed include cytokine-mediated inflammation, thyroid-stimulating hormone receptor and insulin-like growth factor-1 receptor crosstalk, pro-fibrotic signaling, neuro-inflammatory mechanisms, and epithelial stress responses involving mitogen-activated protein kinase and nuclear factor kappa B pathways. We further highlight the challenge of disentangling therapy-induced molecular effects from persistent exposure-related mechanical stress. Understanding how TED therapies modulate ocular surface and adnexal homeostasis is essential for optimizing integrated management strategies that address both orbital inflammation and long-term ocular surface stability.

Thyroid eye disease (TED) produces chronic orbital inflammation that may result in restrictive extraocular myopathy and associated diplopia. TED-related strabismus can be challenging to address due to complex and often large-angle deviations, variable surgical results, high rates of reoperation, and profound impact on patients' function and quality of life. We address the evaluation and management of strabismus in TED, and discuss changes that the recent introduction of teprotumumab may have on timing and treatment options previously chosen.

Graves' orbitopathy (GO) is an autoimmune disease characterized by orbital inflammation, fibroblast activation, and adipogenesis, with limited effective therapies. This study aimed to investigate the role of biglycan (BGN) in GO pathogenesis and its underlying mechanisms. Bioinformatic analyses were performed to identify differentially expressed genes in GO tissues. BGN protein levels were validated in orbital adipose tissues from GO patients. Functional effects of BGN were examined by overexpression or knockdown in human GO orbital fibroblasts (GO-OFs) in vitro. In vivo, a thyroid-associated ophthalmopathy (TAO) mouse model was used to evaluate the effects of Bgn knockdown on orbital fibrosis and adipogenesis. BGN expression was significantly upregulated in GO orbital tissues. In vitro, BGN overexpression promoted, while BGN knockdown attenuated, fibrosis and adipogenesis in GO-OFs. Mechanistically, BGN activated nuclear factor kappa B (NF-κB) and extracellular signal-regulated kinase (ERK) signaling pathways. In vivo, Bgn knockdown reduced GO-like pathological features, including fibrosis and adipose expansion, and decreased NF‑κB and ERK signaling activation. BGN contributes to fibrosis and adipogenesis in GO via NF‑κB and ERK signaling activation. These findings elucidate a pivotal role for BGN in GO pathogenesis and highlight its potential as a therapeutic target for GO treatment.

IL17-related gene polymorphisms associated with orbital inflammatory diseases and their clinical features.

ABSTRACT Background Thyroid-associated ophthalmopathy (TAO)is a common autoimmune inflammatory disorder that compromises visual function and quality of life. It is characterized by orbital tissue inflammation and ocular surface injury. Although immunosuppressive pulse therapy has shown clinical efficacy, its underlying molecular mechanisms remain incompletely understood. Methods Tear samples were collected from 30 healthy controls and 30 patients with TAO before and after immunosuppressive pulse therapy. Proteomic profiling was performed using label-free quantitative liquid chromatography – tandem mass spectrometry (LC-MS/MS), and key proteins involved in FGA expression and complement-coagulation cascade signaling were validated by ELISA. Primary orbital fibroblasts (OFs) were isolated from TAO patients and subjected to FGA overexpression and immunosuppressant treatment. Fibrosis and adipogenic differentiation were assessed using a multidimensional approach, including CCK-8 assay, flow cytometry, Oil Red O staining, qRT-PCR, and Western blotting. Results Immunosuppressive pulse therapy significantly alleviates ocular surface injury in TAO patients, primarily through FGA-mediated regulation of the complement and coagulation cascade pathway. Our findings identify FGA as a promising therapeutic target in TAO. Restoration of FGA expression synergizes with immunosuppressive therapy, highlighting a potential combinatory treatment strategy. Conclusion FGA represents a potential therapeutic target for TAO. Enhancing FGA expression may augment the efficacy of immunosuppressive therapythrough synergistic modulationof inflammatory and fibrotic pathways. Clinical trial number Not applicable.

BackgroundGraves’ disease (GD) is an autoimmune condition that can extend beyond the thyroid, leading to thyroid eye disease (TED), a disorder marked by orbital inflammation and tissue remodeling.MethodsWe explored the therapeutic potential of maraviroc, a CCR5 antagonist, in a mouse model of TED triggered by immunization with the human TSH receptor (hTSHR) A-subunit. Mice received pTriEx1.1neo-hTSHR A-subunit plasmid immunizations, and a subset were treated with maraviroc via drinking water. We assessed thyroid function, orbital tissue changes, immune cell infiltration, and lipid metabolism through serological testing, histology, immunohistochemistry, and untargeted lipidomics.ResultsMaraviroc did not significantly affect anti-TSHR antibody production nor the degree of hyperthyroidism, though it modestly improved thyroid histopathology. Notably, it reduced key signs of orbital disease, including brown adipose tissue expansion, CCL5-positive immune cell infiltration, CD4+ T-cell infiltration and the presence of F4/80+ macrophages. Lipidomic profiling revealed distinct metabolic changes in treated mice, with reduced triacylglycerols and elevated carnitines, indicative of enhanced fatty acid utilization. Composite Z-score analysis reinforced maraviroc’s beneficial effects on orbital inflammation and remodeling.ConclusionMaraviroc shows promise as a targeted therapy for TED in the context of GD, offering anti-inflammatory and anti-adipogenic benefits while sparing thyroid autoimmunity. These preclinical findings support further clinical investigation into its role in managing TED.

To report a case of pathology-confirmed endogenous Nocardia nova panophthalmitis that presented as a choroidal lesion and orbital signs in a patient with history of presumed left renal cell carcinoma and right renal transplant on chronic immunosuppression. Retrospective chart review of a case. A 71-year-old woman with right renal transplant on tacrolimus, presumed left renal cell carcinoma, and recent Aspergillus fumigatus nodular pneumonia presented with subacute right eye pain, eyelid swelling, counting fingers vision, a quiet anterior chamber, posterior synechiae, mild vitritis, and an amelanotic choroidal mass with low internal reflectivity. She was not on treatment for her presumed renal cancer and denied infectious symptoms. Orbital imaging showed abnormal enhancement extending from the mass into the retro-orbital fat. Systemic work-up showed a new mass arising from the transplanted right kidney, with fine-needle aspiration biopsy showing filamentary bacilli and broad-range polymerase chain reaction (PCR) positive for Nocardia nova. The patient underwent enucleation of the right eye, which showed panophthalmitis and a choroidal abscess with Nocardia filamentary bacilli. There were no signs of orbital inflammation after the post-operative month 2 visit. In patients on chronic immunosuppression, endogenous nocardiosis should be considered in the setting of an intraocular mass and orbital inflammation, even in the absence of leukocytosis or systemic symptoms. Early recognition and appropriate management may improve systemic outcomes in Nocardia infections, even when enucleation becomes necessary for local disease control.

Thyroid eye disease (TED) is a vision-threatening and quality-of-life-impairing manifestation of autoimmune thyroid disease, driven by orbital fibroblast activation, inflammation, and tissue remodeling. This review synthesizes current evidence on TED epidemiology and pathogenesis, with a particular focus on the pathogenic synergy between the thyrotropin receptor (TSHR) and the insulin-like growth factor-1 receptor (IGF-1R). We discuss how this receptor complex propagates intracellular signaling that leads to disease hallmarks: fibroblast proliferation, glycosaminoglycan secretion, and adipogenesis. While we outline the established paradigm of management-encompassing glucocorticoids, orbital radiotherapy, and surgery-a key emphasis is placed on the recent therapeutic revolution ushered in by targeted biological agents, most notably IGF-1R inhibition. As well as research on new targets for immunotherapy such as Tregs and other aspects such as IL-6 or TNF-α. Finally, we explore the nascent role of artificial intelligence in refining diagnosis and prognostic assessment. This overview aims to equip clinicians and researchers with a forward-looking perspective on the evolving landscape of TED management.