Idiopathic Orbital Inflammation

A 47-year-old woman with a past medical history of Grave’s disease complicated by thyroid associated ophthalmopathy presents with left eye pain, swelling, and diplopia worsening for 3 months. Exam reveals left-sided periorbital edema, proptosis, and extraocular motility deficits. CT reveals grossly enlarged extraocular muscles. All laboratory testing is normal, including thyroid function tests and thyroid eye disease associated antibodies. Muscle biopsy reveals non-specific inflammation. At this time, a diagnosis of idiopathic orbital inflammation was made. Typically, corticosteroids are a mainstay of treatment in this condition. Orbital radiation therapy offers an additional option. In this patient, both were used, and the treatment course was complicated by steroid dependence and the failure of multiple additional steroid sparing therapies. IVIG therapy offered some relief, however the patient continues to have active disease. 

Presentation Date: 01/30/2020

Issue Date: 08/01/2020