Grand Rounds

Idiopathic orbital inflammation (IOI) is a noninfectious inflammatory condition of the orbit. A patient with Hashimoto thyroiditis presented with 7 weeks of progressive orbital pain and swelling following a preceding viral illness. Examination demonstrated bilateral orbital inflammation with associated bilateral uveitis. Given the atypical intraocular involvement, an extensive evaluation was undertaken to exclude neoplastic, infectious, thyroid-associated, and other systemic autoimmune causes of orbital inflammation. Laboratory testing was unrevealing, and orbital imaging demonstrated diffuse inflammatory changes without evidence of a discrete mass. In the absence of a secondary etiology, a diagnosis of exclusion of IOI was made. Orbital biopsy was deferred because of the lack of red-flag clinical or radiographic features. The patient was treated with intravenous corticosteroids, the standard first-line treatment for IOI, with subsequent clinical improvement. This case illustrates a unique IOI phenotype, highlighting bilateral uveitis as an uncommon accompanying feature. Careful exclusion of neoplastic and systemic inflammatory mimics remains essential before establishing the diagnosis.

Presentation Date: 10/01/2026
Issue Date: 10/02/2026