Diagnosis, Treatment, and Management of Idiopathic Orbital Inflammation (IOI)
Nirali Patel, OD
VA Connecticut, 950 Campbell Ave West Haven, CT
Meghan Cook, OD
VA Connecticut, 950 Campbell Ave West Haven, CT
Crystal DeLuca, OD
VA Connecticut, 950 Campbell Ave West Haven, CT
Nancy Shenouda-Awad, OD, FAAO
VA Connecticut, 950 Campbell Ave West Haven, CT
Abstract
Idiopathic Orbital Inflammation (IOI) is a diagnosis of exclusion, since its clinical
presentation is highly variable and mimics other conditions. This poster discusses a case
of IOI, the clinical features, diagnosis, and treatment/management options.
I.
Case History
 89 year old white male
 Chief Complaint:
o Developed subconjunctival hemorrhage OS 3 days prior
o Redness OS with sharp pain lasting seconds
o Associated symptoms:
1. intense itching OS with foreign body sensation
2. Binocular horizontal diplopia with no pain
3. Unable to lift eyelid OS
 Ocular history
o History of normal tension glaucoma suspect secondary to
moderate cupping
o Blepharitis OU
 Medical history
o Benign Prostatic Hyperplasia
o H/O Orthostatic syncope
 Medications
o Asprin 81 mg
o Paroxetine 12.5 mg
o Tamsulosin HCL 0.4 mg
II.
Pertinent Findings
 Clinical:
o Best corrected distance acuity: 20/20-3 OD, 20/70- OS
o Pupils within normal limits, Abduction deficit OS
o Anterior Segment:
1. Ecchymosis with mild ptosis most likely mechanical



secondary to patient significantly rubbing his eyes due to
tearing OS
2. Grade 3 injection in all quadrants of sclera with chemosis,
nasally a raised hyperemic area of trapped blood OS
3. No anterior chamber reaction OD, Baseline pigment cells
in anterior chamber OS
o Fundus Exam:
1. Remarkable for familial drusen OU
2. Mild anemic retinopathy OD
Physical:
o Blood pressure 122/64
Laboratory studies:
o Creatinine 1.0 mg/dL
o Urea Nitrogen 19 mg/dL
Imaging:
o MRI conclusive of inflammatory changes in the left periorbital
and preseptal regions. Negative for any orbital neoplasm
III.
Differential diagnosis
 Primary: Acute IOI with sixth nerve palsy
 Others:
o Scleritis/Episcleritis
o Orbital cellulitis
o Inflammatory reaction to foreign body or trauma
o Thyroid Orbitopathy
o Sarcoidosis
o Vasculitis
o Neoplasm
IV.
Diagnosis and discussion
 Findings of pain with grade 3 injection suggest an inflammatory reaction.
 Decrease in vision with mild anterior chamber reaction suggestive of an
inflammatory reaction as well
 Restriction upon abduction suggestive of a sixth nerve palsy
 MRI conclusive of inflammatory changes in the left periorbital and
preseptal regions but negative for any orbital neoplasm
V.
Treatment and management
 Based on the MRI results and the ocular presentation, the patient was
started on systemic steroids 80 mg/day
 Patient was followed two days later where his symptom of diplopia
resolved and there was decrease in pain and injection
 Within 1 week the patient’s distance acuity was at baseline 20/20 OS and
he was asymptomatic
 The steroid was tapered off steroid starting from the first follow-up and
discontinued 2 weeks later
VI.
Conclusion
 IOI is a diagnosis of exclusion with highly variable clinical features and
outcome
 Imaging such as CT scan or MRI is a very important diagnostic tool that
helps identify the place of inflammation
 Based on current literature, systemic steroids are first-line of therapy for
patients with IOI
 For cases that are not responsive to steroids, other therapies include nonsteroidal anti-inflammatory agents, immunosuppressants, radiation
therapy, chemotherapy, and surgical intervention, though each has their
own limitations