(See also Introduction to Eye Socket Disorders Introduction to Eye Socket Disorders The eye sockets (orbits) are bony cavities that contain and protect the eyes and their supporting structures (see figures An Inside Look at the Eye and Structures That Protect the Eye). Disorders... read more .)
People of all ages can be affected. Inflammation can be brief or long lasting, may or may not be caused by an infection, and can recur.
Causes of Orbital Inflammation
Inflammation of the orbit can be the result of a bodywide (systemic) inflammatory disorder. Sometimes the inflammation affects only the orbit. Inflammation can be caused by infection or by a noninfectious disorder. Inflammation of the orbit due to infection that affects the eyelid, skin, and tissues around the front of the eye is called preseptal cellulitis Preseptal Cellulitis Preseptal cellulitis is infection of the eyelid and of the skin and tissues around the front of the eye. (See also Introduction to Eye Socket Disorders.) Both preseptal cellulitis and orbital... read more . Inflammation that affects the tissue within the orbit and around and behind the eye is called orbital cellulitis Orbital Cellulitis Orbital cellulitis is infection affecting the tissue within the orbit and around and behind the eye. Infection can spread to the orbit from sources such as the sinuses around the nose. Symptoms... read more . Noninfectious orbital inflammation has many causes. The most common cause of noninfectious inflammation of the eye socket is thyroid eye disease (also known as Graves ophthalmopathy Graves disease Hyperthyroidism is overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions. Graves disease is the most common cause of hyperthyroidism... read more ).
Systemic inflammatory disorders that affect the eye/orbit include granulomatosis with polyangiitis Granulomatosis with Polyangiitis Granulomatosis with polyangiitis often begins with inflammation of small- and medium-sized blood vessels and tissues in the nose, sinuses, throat, lungs, or kidneys. The cause is unknown. The... read more (formerly known as Wegener granulomatosis), in which there is generalized inflammation of blood vessels (called vasculitis Overview of Vasculitis Vasculitic disorders are caused by inflammation of the blood vessels (vasculitis). Vasculitis can be triggered by certain infections or drugs or can occur for unknown reasons. People may have... read more ). Another type of inflammation is called IgG4-related orbital inflammation (see also IgG4-Related Disease IgG4-Related Disease Immunoglobulin G4-related disease (IgG4-RD) is an uncommon immune disorder that usually affects multiple tissues and organs with tumor-like masses and/or painless enlargement. Symptoms depend... read more ). IgG4-related orbital inflammation can affect the same structures as granulomatosis with polyangiitis but typically has fewer symptoms.
Inflammatory disorders that affect only the eye include scleritis Scleritis Scleritis is severe, destructive inflammation of the sclera (the tough, white, fiber layer covering the eye) that may threaten vision. Scleritis sometimes occurs in people who have a bodywide... read more , in which the white coat of the eye (sclera) becomes inflamed. Eyelid disorders Eyelid and Tearing Disorders with inflammation are discussed elsewhere. Inflammation affecting any or all parts of the orbit is called inflammatory orbital pseudotumor (which is not really a tumor and is not a cancer) or nonspecific orbital inflammation. Inflammation affecting the tear (lacrimal) gland, located at the upper outer edge of the orbit (see figure ), is called dacryoadenitis. Inflammation affecting one of the muscles that move the eye is called myositis.
Symptoms of Orbital Inflammation
Symptoms vary depending on which structures are actually inflamed. In general, symptoms start rather suddenly, typically over a few days. Pain and redness of the eyeball or eyelid usually occur. Pain can be severe and incapacitating at times. Abnormal bulging of the eyes (proptosis Eyes, Bulging Bulging or protruding of one or both eyes is called proptosis or exophthalmos. Exophthalmos is usually used when describing bulging eyes caused by Graves disease, a disorder causing overactivity... read more ), double vision, and vision loss are also possible. Symptoms related to IgG4-related orbital inflammation, on the other hand, are usually minimal. Rarely is there any discomfort, but rather proptosis and eyelid swelling Eyelid Swelling A person may experience swelling in one or both eyelids. Swelling may be painless or accompanied by itching or pain. Eyelid swelling is distinct from bulging eyes, although a few disorders can... read more are common. Other symptoms depend upon the disorder causing the orbital inflammation.
Diagnosis of Orbital Inflammation
Computed tomography or magnetic resonance imaging
Other tests to determine the cause
Computed tomography Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) A variety of tests can be done to confirm an eye problem or to determine the extent or severity of an eye disorder. Each eye is tested separately. In general, angiography involves injecting... read more (CT) or magnetic resonance imaging Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) A variety of tests can be done to confirm an eye problem or to determine the extent or severity of an eye disorder. Each eye is tested separately. In general, angiography involves injecting... read more (MRI) is done. A doctor may do other blood tests and take a sample from the inflamed area for examination under a microscope (biopsy) to determine the cause.
Treatment of Orbital Inflammation
Drugs to treat inflammation (corticosteroids)
Radiation therapy or drugs to change immune response and treat the underlying cause
Many disorders causing inflammation of the orbit are treated with a corticosteroid drug, which can be given by mouth. Corticosteroids can be given by vein (intravenously) if the inflammation is severe. Radiation therapy or drugs and treatments that change the body’s immune responses may sometimes be used. IgG4 typically responds to corticosteroids or, if necessary, other drugs to change the body's immune response (for example, rituximab).
Sometimes surgery is needed to help resolve or prevent progression of thyroid eye disease.