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Update on Treatment of Idiopathic (and Non-Idiopathic) Orbital Inflammation

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Abstract

Purpose of review

This review aims to provide a critical appraisal of current diagnostic and therapeutic strategies for patients with orbital inflammatory disease (OID). We present the reader with a review of clinical, imaging, laboratory, and biopsy based assessment of OID and review the current treatment modalities utilized including corticosteroids, corticosteroid-sparing (immunomodulatory) agents, radiation, antibiotics, and disease specific therapy.

Recent findings

Two major developments and trends have emerged in the management of orbital inflammation. First, improved understanding and distinction of inflammation subtypes (myositis, dacryoadenitis, or infiltrative) allows for more nuanced workup and treatment. Second, immunomodulatory agents have shown promise in achieving disease control in cases of truly idiopathic or corticosteroid-resistant OID. Together, these advances have led to fewer adverse effects and better efficacy.

Summary

The optimal treatment of OID depends on distinguishing between nonspecific and specific inflammation. Nonspecific inflammation tends to respond to corticosteroid therapy with a lower chance of relapse, while specific orbital inflammation often requires targeting the underlying disease with steroid-sparing therapy and immunomodulatory agents.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •  Of importance •• Of major importance

  1. Pakdaman MN, Sepahdari AR, Elkhamary SM. Orbital inflammatory disease: Pictorial review and differential diagnosis. World J Radiol. 2014 [cited 2024 Jan 3];6(4):106. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000606/.

    Article  PubMed  PubMed Central  Google Scholar 

  2. • Rachwani-Anil R, Zamorano-Martín F, Rocha-de-Lossada C, García-Lorente M, Pérez-Casaseca C, Hernando-Ayala C, et al. Orbital inflammatory disease. Arch Soc Esp Oftalmol. 2022 [cited 2024 Jan 3];97(2):89–99. Available from: https://pubmed.ncbi.nlm.nih.gov/35152954/. This is a recent and thorough review of orbital inflammation that provides another perspective on similar topics.

    Article  CAS  PubMed  Google Scholar 

  3. Rose GE, Verity DH. Neuro-ophthalmology of orbital disease. Handb Clin Neurol. 2011;102:467–91.

    Article  PubMed  Google Scholar 

  4. Gordon LK. Diagnostic dilemmas in orbital inflammatory disease. Ocul Immunol Inflamm. 2003 [cited 2024 Jan 3];11(1):3–15. Available from: https://www.tandfonline.com/doi/abs/10.1076/ocii.11.1.3.15577.

    Article  PubMed  Google Scholar 

  5. Yuen SJA, Rubin PAD. Idiopathic orbital inflammation: distribution, clinical features, and treatment outcome. Arch Ophthalmol. 2003 [cited 2024 Jan 3];121(4):491–9. Available from: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/415221.

    Article  PubMed  Google Scholar 

  6. Weber AL, Romo LV, Sabates NR. Pseudotumor of the orbit: clinical, pathologic, and radiologic evaluation. Radiol Clin North Am. 1999;37(1):151–68.

    Article  CAS  PubMed  Google Scholar 

  7. Aakalu LJA, Wendel P, Setabutr R, Kapur AR, Sepahdari MF, Mafee AM, et al. MR imaging of orbital inflammatory syndrome, orbital cellulitis, and orbital lymphoid lesions: the role of diffusion-weighted imaging. Am J Neuroradiol. 2009 [cited 2024 Jan 3];30(1):64–70. Available from: https://www.ajnr.org/content/30/1/64.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mottow-Lippa L, Jakobiec FA, Smith M. Idiopathic inflammatory orbital pseudotumor in childhood. II. Results of diagnostic tests and biopsies. Ophthalmology. 1981 [cited 2024 Jan 3];88(6):565–74. Available from: https://pubmed.ncbi.nlm.nih.gov/7267028/.

    Article  CAS  PubMed  Google Scholar 

  9. Mottow LS, Jakobiec FA. Idiopathic inflammatory orbital pseudotumor in childhood: I. Clinical characteristics. Arch Ophthalmol. 1978 [cited 2024 Jan 3];96(8):1410–7. Available from: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/632705.

    Article  CAS  PubMed  Google Scholar 

  10. Berger JW, Rubin PAD, Jakobiec FA. Pediatric orbital pseudotumor: case report and review of the literature. Int Ophthalmol Clin. 1996 [cited 2024 Jan 3];36(1):161–77. Available from: https://pubmed.ncbi.nlm.nih.gov/8778063/.

    Article  CAS  PubMed  Google Scholar 

  11. Purcell JJ, Taulbee WA. Orbital myositis after upper respiratory tract infection. Arch Ophthalmol. 1981 [cited 2024 Jan 3];99(3):437–8. Available from: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/633725.

    Article  PubMed  Google Scholar 

  12. Easton JA, Smith WT. Non-specific granuloma of orbit (‘orbital pseudotumour’). J Pathol Bacteriol. 1961;82(2):345–54. https://doi.org/10.1002/path.1700820212.

    Article  CAS  PubMed  Google Scholar 

  13. Serop S, Vianna RNG, Claeys M, De Laey JJ. Orbital myositis secondary to systemic lupus erythematosus. Acta Ophthalmol. 1994 [cited 2024 Jan 3];72(4):520–3. Available from: https://pubmed.ncbi.nlm.nih.gov/7825423/.

    Article  CAS  Google Scholar 

  14. Squires RH, Zwiener RJ, Kennedy RH. Orbital myositis and Crohn’s disease. J Pediatr Gastroenterol Nutr. 1992 [cited 2024 Jan 3];15(4):448–51. Available from: https://pubmed.ncbi.nlm.nih.gov/1469529/.

    PubMed  Google Scholar 

  15. Van Mosselaer G, Van Deuren H, Dewolf Peeters C, Missotten L. Pseudotumor orbitae and myasthenia gravis. A case report. Arch Ophthalmol (Chicago, Ill 1960). 1980 [cited 2024 Jan 3];98(9):1621–2. Available from: https://pubmed.ncbi.nlm.nih.gov/7425926/.

    Article  Google Scholar 

  16. Liou VD, Yoon MK, Maher M, Chwalisz BK. Orbital inflammation in myelin oligodendrocyte glycoprotein antibody–associated disease: a case report and review of the literature. J Neuro-Ophthalmology. 2022;42(1):E56-62.

    Article  Google Scholar 

  17. Mihailova D, Grigorova R, Vassileva B, Mladenova G, Ivanova N, Stephanov S, et al. Autoimmune thyroid disorders in juvenile chronic arthritis and systemic lupus erythematosus. Adv Exp Med Biol. 1999 [cited 2024 Jan 3];455:55–60. Available from: https://link.springer.com/chapter/10.1007/978-1-4615-4857-7_8.

    Article  CAS  PubMed  Google Scholar 

  18. Siatkowski RM, Capo H, Byrne SF, Gendron EK, Flynn JT, Munoz M, et al. Clinical and echographic findings in idiopathic orbital myositis. Am J Ophthalmol. 1994;118(3):343–50.

    Article  CAS  PubMed  Google Scholar 

  19. Mombaerts I, Schlingemann RO, Goldschmeding R, Koornneef L. Idiopathic granulomatous orbital inflammation. Ophthalmology. 1996;103(12):2135–41.

    Article  CAS  PubMed  Google Scholar 

  20. Espinoza GM. Orbital inflammatory pseudotumors: etiology, differential diagnosis, and management. Curr Rheumatol Rep. 2010 [cited 2024 Jan 3];12(6):443–7. Available from: https://link.springer.com/article/10.1007/s11926-010-0128-8.

    Article  PubMed  Google Scholar 

  21. Flanders AE, Mafee MF, Rao VM, Choi KH. CT Characteristics of orbital pseudotumors and other orbital inflammatory processes. J Comput Assist Tomogr. 1989;13(1):40–7.

    Article  CAS  PubMed  Google Scholar 

  22. Mallika P, Tan A, Aziz S, Alwi SS, Chong M, Vanitha R, et al. Thyroid associated ophthalmopathy – a review. Malaysian Fam Physician Off J Acad Fam Physicians Malaysia. 2009 [cited 2021 Oct 16];4(1):8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25606151/.

    Google Scholar 

  23. Rootman J. Inflammatory diseases of the orbit. Highlights J Fr Ophtalmol. 2001;24(2):155–61.

    CAS  PubMed  Google Scholar 

  24. Watkins LM, Carter KD, Nerad JA. Ocular adnexal lymphoma of the extraocular muscles: case series from the University of Iowa and review of the literature. Ophthal Plast Reconstr Surg. 2011 [cited 2024 Jan 3];27(6):471–6. Available from: https://journals.lww.com/op-rs/fulltext/2011/11000/ocular_adnexal_lymphoma_of_the_extraocular.31.aspx.

    Article  PubMed  Google Scholar 

  25. Ahmad SM, Esmaeli B. Metastatic tumors of the orbit and ocular adnexa. Curr Opin Ophthalmol. 2007 [cited 2024 Jan 3];18(5):405–13. Available from: https://journals.lww.com/co-ophthalmology/fulltext/2007/09000/metastatic_tumors_of_the_orbit_and_ocular_adnexa.11.aspx.

    Article  PubMed  Google Scholar 

  26. Papavasileiou E, Prasad S, Freitag SK, Sobrin L, Lobo A-M. Ipilimumab-induced ocular and orbital inflammation—a case series and review of the literature. Ocul Immunol Inflamm. 2016 [cited 2024 Jan 15];24(2):140–6. Available from: https://www.tandfonline.com/doi/abs/10.3109/09273948.2014.1001858?casa_token=GaY5cBTH5zEAAAAA:IRa7sZAeyYuc_AOaMV1jaOLUiqiM3tpnVydzFautUQXQ3ipvw_2jYnriLH-F0JDd0--2BwHnAc1UEDw.

    CAS  PubMed  Google Scholar 

  27. Al-Zubidi N, Oku H, Verner-Cole E, Yamada K, Chevez-Barrios P, Tonari M, et al. Immunoglobulin G4-positive sclerosing idiopathic orbital inflammation: new neuro-ophthalmological presentations. Neuro-Ophthalmology. 2013 [cited 2024 Jan 15];37(1):24–30. Available from: https://www.tandfonline.com/doi/abs/10.3109/01658107.2012.752853.

    Article  PubMed  PubMed Central  Google Scholar 

  28. •• Saitakis G, Chwalisz BK. The neurology of IGG4-related disease. J Neurol Sci. 2021;424:117420. IgG4 related disease is a relatively recently appreciated entity that accounts for a significant portion of specific orbital inflammation as well nervous system disease. This comprehensive study provides an update on recent thinking in IgG4 disease in terms of pathogenesis, numerous subtleties of diagnosis, and treatment.

    Article  CAS  PubMed  Google Scholar 

  29. Jiv S, Nagpal S, Suresh M, Chari T. Immunoglobulin G4 levels. JAMA. 2019 [cited 2024 Jan 15];321(2):202–3. Available from: https://jamanetwork.com/journals/jama/fullarticle/2719582.

    Article  Google Scholar 

  30. Xia C. Diagnostic performances of serum IgG4 concentration and IgG4/IgG ratio in IgG4-related disease. Clin Rheumatol. 2017 [cited 2024 Jan 15];36(12):2769–74. Available from: https://link.springer.com/article/10.1007/s10067-017-3685-7.

    Article  PubMed  Google Scholar 

  31. Ohshima KI, Sogabe Y, Sato Y. The usefulness of infraorbital nerve enlargement on MRI imaging in clinical diagnosis of IgG4-related orbital disease. Jpn J Ophthalmol. 2012 [cited 2024 Jan 15];56(4):380–2. Available from: https://link.springer.com/article/10.1007/s10384-012-0151-6.

    Article  PubMed  Google Scholar 

  32. Soussan JB, Deschamps R, Sadik JC, Savatovsky J, Deschamps L, Puttermann M, et al. Infraorbital nerve involvement on magnetic resonance imaging in European. Eur Radiol. 2017 [cited 2024 Jan 15];27(4):1335–43. Available from: https://link.springer.com/article/10.1007/s00330-016-4481-5.

    Article  PubMed  Google Scholar 

  33. McNab AA, Mckelvie P. IgG4-related ophthalmic disease. Part II: Clinical aspects. Ophthal Plast Reconstr Surg. 2015 [cited 2024 Jan 15];31(3):167–78. Available from: https://journals.lww.com/op-rs/fulltext/2015/05000/igg4_related_ophthalmic_disease__part_ii__clinical.1.aspx.

    Article  PubMed  Google Scholar 

  34. Shah SS, Lowder CY, Schmitt MA, Wilke WS, Kosmorsky GS, Meisler DM. Low-dose methotrexate therapy for ocular inflammatory disease. Ophthalmology. 1992;99(9):1419–23.

    Article  CAS  PubMed  Google Scholar 

  35. Das Narla L, Newman B, Spottswood SS, Narla S, Kolli R. Inflammatory pseudotumor. Radiographics. 2003 [cited 2024 Jan 3];23(3):719–29. Available from: https://pubmed.ncbi.nlm.nih.gov/12740472/.

    Article  Google Scholar 

  36. Garrity JA, Kennerdell JS, Johnson BL, Ellis LD. Cyclophosphamide in the treatment of orbital vasculitis. Am J Ophthalmol. 1986;102(1):97–103.

    Article  CAS  PubMed  Google Scholar 

  37. Yoon MK, McCulley TJ. Orbital Disease in Neuro-Ophthalmology. Neurol Clin. 2010 [cited 2024 Jan 15];28(3):679–99. Available from: http://www.neurologic.theclinics.com/article/S0733861910000460/fulltext.

    Article  PubMed  Google Scholar 

  38. Dagi Glass LR, Freitag SK. Orbital inflammation: corticosteroids first. Surv Ophthalmol. 2016;61(5):670–3.

    Article  PubMed  Google Scholar 

  39. Masaki Y, Matsui S, Saeki T, Tsuboi H, Hirata S, Izumi Y, et al. A multicenter phase II prospective clinical trial of glucocorticoid for patients with untreated IgG4-related disease. Mod Rheumatol. 2017 [cited 2024 Jan 15];27(5):849–54. https://doi.org/10.1080/14397595.2016.1259602.

    Article  CAS  PubMed  Google Scholar 

  40. Bijlsma WR, Paridaens D, Kalmann R. Treatment of severe idiopathic orbital inflammation with intravenous methylprednisolone. Br J Ophthalmol. 2011 [cited 2024 Jan 15];95(8):1068–71. Available from: https://pubmed.ncbi.nlm.nih.gov/21349945/.

    Article  PubMed  Google Scholar 

  41. Mombaerts I, Schlingemann RO, Goldschmeding R, Koornneef L. Are systemic corticosteroids useful in the management of orbital pseudotumors? Ophthalmology. 1996;103(3):521–8.

    Article  CAS  PubMed  Google Scholar 

  42. Mombaerts I, Rose GE, Garrity JA. Orbital inflammation: biopsy first. Surv Ophthalmol. 2016;61(5):664–9.

    Article  PubMed  Google Scholar 

  43. Reggie S, Neimkin M, Holds J. Intralesional corticosteroid injections as treatment for non-infectious orbital inflammation. Orbit. 2018 [cited 2024 Jan 15];37(1):41–7. Available from: https://www.tandfonline.com/doi/abs/10.1080/01676830.2017.1353110.

    Article  PubMed  Google Scholar 

  44. Andrew NH, Gajdatsy A, Selva D. Intraorbital corticosteroid injection for the treatment of IgG4-related ophthalmic disease. Br J Ophthalmol. 2016;100(5):644–7.

    Article  PubMed  Google Scholar 

  45. Wu A, Andrew NH, Tsirbas A, Tan P, Gajdatsy A, Selva D. Rituximab for the treatment of IgG4-related orbital disease: experience from five cases. Eye 2015 291. 2014 [cited 2024 Jan 15];29(1):122–8. Available from: https://www.nature.com/articles/eye2014251.

    Google Scholar 

  46. Ebbo M, Grados A, Samson M, Groh M, Loundou A, Rigolet A, et al. Long-term efficacy and safety of rituximab in IgG4-related disease: data from a French nationwide study of thirty-three patients. PLoS One. 2017 [cited 2024 Jan 15];12(9):e0183844. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183844.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Suhler EB, Lim LL, Beardsley RM, Giles TR, Pasadhika S, Lee ST, et al. Rituximab therapy for refractory orbital inflammation: results of a phase 1/2, dose-ranging, randomized clinical trial. JAMA Ophthalmol. 2014 [cited 2024 Jan 15];132(5):572–8. Available from: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/1847500.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. •• Ng CC, Sy A, Cunningham ET. Rituximab for treatment of non-infectious and non-malignant orbital inflammatory disease. J Ophthalmic Inflamm Infect. 2021 [cited 2024 Jan 15];11(1):1–12. Available from: https://joii-journal.springeropen.com/articles/10.1186/s12348-021-00253-3. An important review of rituximab for orbital inflammation, incorporating every study available up until January 2021, resulting in 167 patients. These were patients with orbitla inflammation that received rituximab. This paper provides valuable insights into not only outcomes, but also treatment patterns and protocols used. 

    Article  Google Scholar 

  49. Smith JR, Rosenbaum JT. A role for methotrexate in the management of non-infectious orbital inflammatory disease. Br J Ophthalmol. 2001 [cited 2024 Jan 15];85(10):1220–4. Available from: https://bjo.bmj.com/content/85/10/1220.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Kokotis P, Theodossiadis P, Bouros C, Sfikakis PP. Bilateral ocular myositis as a late complication of dermatomyositis. J Rheumatol. 2005;32(2):379–81. PMID: 15693104.

    PubMed  Google Scholar 

  51. Garrity JA, Coleman AW, Matteson EL, Eggenberger ER, Waitzman DM. Treatment of recalcitrant idiopathic orbital inflammation (chronic orbital myositis) with infliximab. Am J Ophthalmol. 2004;138(6):925–30.

    Article  CAS  PubMed  Google Scholar 

  52. El Nokrashy A, Lightman S, Tomkins-Netzer O. Efficacy of infliximab in disease control of refractory orbital myositis. Ocul Immunol Inflamm. 2023 [cited 2024 Feb 6];31(1):153–7. Available from: https://www.tandfonline.com/doi/abs/10.1080/09273948.2021.2001663.

    Article  PubMed  Google Scholar 

  53. Miquel T, Abad S, Badelon I, Vignal C, Warzocha U, Larroche C, et al. Successful treatment of idiopathic orbital inflammation with infliximab: an alternative to conventional steroid-sparing agents. Ophthal Plast Reconstr Surg. 2008 [cited 2024 Jan 15];24(5):415–7. Available from: https://journals.lww.com/op-rs/fulltext/2008/09000/successful_treatment_of_idiopathic_orbital.21.aspx.

    Article  PubMed  Google Scholar 

  54. Hernández-Garfella ML, Gracia-García A, Cervera-Taulet E, García-Villanueva C, Montero-Hernández J. Adalimumab for recurrent orbital myositis in Crohn’s disease: report of a case with a 3-year follow-up. J Crohn’s Colitis. 2011 [cited 2024 Jan 15];5(3):265–6. https://doi.org/10.1016/j.crohns.2011.02.010.

    Article  Google Scholar 

  55. Adams AB, Kazim M, Lehman TJ. Treatment of orbital myositis with adalimumab (Humira). J Rheumatol. 2005;32(7):1374–5. PMID: 15996084.

    PubMed  Google Scholar 

  56. Couderc M, Mathieu S, Tournadre A, Dubost JJ, Soubrier M. Acute ocular myositis occurring under etanercept for rheumatoid arthritis. Jt Bone Spine. 2014;81(5):445–6.

    Article  CAS  Google Scholar 

  57. Chang V, McCurdy D, Gordon LK. Etanercept associated optic neuropathy. Clin Experiment Ophthalmol. 2007 [cited 2024 Jan 15];35(7):680–2. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1442-9071.2007.01541.x.

    Article  PubMed  Google Scholar 

  58. Jordan DR, Park JSY, Al-Breiki D. Acute orbital inflammation with loss of vision: a paradoxical adverse event associated with infliximab therapy for Crohn’s disease. Orbit. 2022 [cited 2024 Jan 15];41(6):791–6. Available from: https://www.tandfonline.com/doi/abs/10.1080/01676830.2021.1939726.

    Article  PubMed  Google Scholar 

  59. Caramaschi P, Biasi D, Carletto A, Bambara L. Orbital myositis in a rheumatoid arthritis patient during etanercept treatment. Clin Exp Rheumatol. 2003;21(1):136.

    CAS  PubMed  Google Scholar 

  60. Hibino M, Kondo T. Dacryoadenitis with ptosis and diplopia as the initial presentation of granulomatosis with polyangiitis. Intern Med. 2017 [cited 2024 Jan 15];56(19):2649–53. Available from: http://internmed.jp.

    Article  PubMed  PubMed Central  Google Scholar 

  61. • Vahdani K, Rose GE. Sarcoid orbital myopathy: clinical presentation and outcomes. Ophthal Plast Reconstr Surg. 2020;36(1):61–6. Sarcoidosis is one of the more common causes of orbital inflammation with specific diagnosable etiology, this recent study provides a relatively large of patients and provides important characterization of presentation, diagnosis, and treatment.

    Article  PubMed  Google Scholar 

  62. Hatton MP, Rubin PAD, Foster CS. Successful treatment of idiopathic orbital inflammation with mycophenolate mofetil. Am J Ophthalmol. 2005;140(5):916–8.

    Article  CAS  PubMed  Google Scholar 

  63. Wang L, Zhang P, Wang M, Feng R, Lai Y, Peng L, et al. Failure of remission induction by glucocorticoids alone or in combination with immunosuppressive agents in IgG4-related disease: a prospective study of 215 patients. Arthritis Res Ther. 2018 [cited 2024 Jan 15];20(1):1–12. Available from: https://link.springer.com/articles/10.1186/s13075-018-1567-2.

    Article  Google Scholar 

  64. Gumus K, Mirza GE, Cavanagh HD, Karakucuk S. Topical cyclosporine A as a steroid-sparing agent in steroid-dependent idiopathic ocular myositis with scleritis: a case report and review of the literature. Eye Contact Lens. 2009 [cited 2024 Jan 15];35(5):275–8. Available from: https://journals.lww.com/claojournal/fulltext/2009/09000/topical_cyclosporine_a_as_a_steroid_sparing_agent.14.aspx.

    Article  PubMed  Google Scholar 

  65. Zacharopoulos IP, Papadaki T, Manor RS, Briscoe D. Treatment of idiopathic orbital inflammatory disease with cyclosporine-A: a case presentation. Semin Ophthalmol. 2009 [cited 2024 Jan 15];24(6):260–1. Available from: https://www.tandfonline.com/doi/abs/10.3109/08820530903392639.

    Article  PubMed  Google Scholar 

  66. Sanchez-Roman J, Varela-Aguilar JM, Bravo-Ferrer J, Sequeiros Madueno E, Fernandez De Bobadilla M. Idiopathic orbital myositis: treatment with cyclosporin. Ann Rheum Dis. 1993 Fernandez De Bobadilla;52(1):84. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1004969/.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Meca Casasnovas N, Sangrador Pelluz C, Sotoca J. Tocilizumab as an alternative for corticosteroid-refractory orbital myositis. J Neuroimmunol. 2021;15(356): 577573.

    Article  Google Scholar 

  68. Lanciano R, Fowble B, Sergott RC, Atlas S, Savino PJ, Bosley TM, et al. The results of radiotherapy for orbital pseudotumor. Int J Radiat Oncol. 1990;18(2):407–11.

    Article  CAS  Google Scholar 

  69. Matthiesen C, Bogardus C, Thompson JS, Farris B, Hildebrand L, Wilkes B, et al. The efficacy of radiotherapy in the treatment of orbital pseudotumor. Int J Radiat Oncol. 2011;79(5):1496–502.

    Article  Google Scholar 

  70. Nuzzi R, Trossarello M, Bartoncini S, Marolo P, Franco P, Mantovani C, et al. Ocular complications after radiation therapy: an observational study. Clin Ophthalmol. 2020 [cited 2021 Sep 2];14:3153. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/33116366/.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Donaldson SS, Ross McDougall I, Egbert PR, Enzmann DR, Kriss JP. Treatment of orbital pseudotumor (idiopathic orbital inflammation) by radiation therapy. Int J Radiat Oncol. 1980;6(1):79–86.

    Article  CAS  Google Scholar 

  72. On AV, Hirschbein MJ, Williams HJ, Karesh JW. CyberKnife radiosurgery and rituximab in the successful management of sclerosing idiopathic orbital inflammatory disease. Ophthal Plast Reconstr Surg. 2006 [cited 2024 Feb 6];22(5):395–7. Available from: https://journals.lww.com/op-rs/fulltext/2006/09000/cyberknife_radiosurgery_and_rituximab_in_the.20.aspx.

    Article  PubMed  Google Scholar 

  73. Carvounis PE, Mehta AP, Geist CE. Orbital myositis associated with Borrelia burgdorferi (Lyme disease) infection. Ophthalmology. 2004;111(5):1023–8.

    Article  PubMed  Google Scholar 

  74. Jebaraj AP, Etheridge TJ, Winegar BA, Marx DP. Ipilimumab-related orbitopathy: a case report. Orbit. 2022 [cited 2024 Jan 15]. Available from: https://www.tandfonline.com/doi/abs/10.1080/01676830.2022.2074049.

  75. Nardin C, Borot S, Beaudoin MA, Cattin F, Puzenat E, Gauthier AS, et al. Long-term adverse event: inflammatory orbitopathy induced by pembrolizumab in a patient with metastatic melanoma. Invest New Drugs. 2019 [cited 2024 Jan 15];37(2):375–7. Available from: https://link.springer.com/article/10.1007/s10637-018-0659-9.

    Article  CAS  PubMed  Google Scholar 

  76. Sagiv O, Kandl TJ, Thakar SD, Thuro BA, Busaidy NL, Cabanillas M, et al. Extraocular muscle enlargement and thyroid eye disease-like orbital inflammation associated with immune checkpoint inhibitor therapy in cancer patients. Ophthal Plast Reconstr Surg. 2019 [cited 2024 Jan 15];35(1):50–2. Available from: https://journals.lww.com/op-rs/fulltext/2019/01000/extraocular_muscle_enlargement_and_thyroid_eye.11.aspx.

    Article  PubMed  Google Scholar 

  77. Ryan PJ, Sampath R. Idiopathic orbital inflammation following intravenous pamidronate. Rheumatology. 2001 [cited 2024 Jan 15];40(8):956–7. Available from: https://dx.doi.org/10.1093/rheumatology/40.8.956.

    Article  CAS  PubMed  Google Scholar 

  78. Lefebvre DR, Mandeville JT, Yonekawa Y, Arroyo JG, Torun N, Freitag SK. A case series and review of bisphosphonate-associated orbital inflammation. Ocul Immunol Inflamm. 2016 [cited 2024 Jan 15];24(2):134–9. Available from: https://www.tandfonline.com/doi/abs/10.3109/09273948.2014.942747.

    CAS  PubMed  Google Scholar 

  79. Pirbhai A, Rajak SN, Goold LA, Cunneen TS, Wilcsek G, Martin P, et al. Bisphosphonate-induced orbital inflammation: a case series and review. Orbit. 2015;34(6):331–5.

    Article  PubMed  Google Scholar 

  80. Subramanian PS, Kerrison JB, Calvert PC, Miller NR. Orbital inflammatory disease after pamidronate treatment for metastatic prostate cancer. Arch Ophthalmol. 2003;121(9):1335–6.

    Article  PubMed  Google Scholar 

  81. Khalid M, Micieli J, DeAngelis D, Micieli J. Zoledronic acid-induced orbital inflammation. BMJ Case Rep. 2022 [cited 2024 Jan 15];14(8). Available from: https://www.researchgate.net/profile/Muhammad-Khalid-218/publication/354016727_Zoledronic_acid-induced_orbital_inflammation/links/63bbd0a403aad5368e766e41/Zoledronic-acid-induced-orbital-inflammation.pdf.

  82. Phillips PM, Newman SA. Orbital inflammatory disease after intravenous infusion of zoledronate for treatment of metastatic renal cell carcinoma. Arch Ophthalmol. 2008 [cited 2024 Jan 15];126(1):137–9. Available from: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/420182.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, University of California-San Francisco, 490 Illinois St., San Francisco, CA, 94158, USA

    Elana Meer MD & Jonathan E. Lu MD

  2. Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Michael K. Yoon MD

  3. Department of Ophthalmology, Harvard Medical School, Boston, MA, USA

    Michael K. Yoon MD

Authors
  1. Elana Meer MD
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  2. Michael K. Yoon MD
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  3. Jonathan E. Lu MD
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Contributions

EM and JL contributed to the writing of the main manuscript text. MY contributed to the overall review of the manuscript and provided additional texts and recommendations on review of the manuscript. JL prepared Figure 1 and served as senior author performing final review and edits on the manuscript. All authors reviewed the manuscript.

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Correspondence to Jonathan E. Lu MD.

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Elana Meer, Michael K. Yoon and Jonathan E. Lu each declare no conflict of interest.

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Meer, E., Yoon, M.K. & Lu, J.E. Update on Treatment of Idiopathic (and Non-Idiopathic) Orbital Inflammation. Curr Treat Options Neurol 26, 151–167 (2024). https://doi.org/10.1007/s11940-024-00788-5

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