Bilateral idiopathic orbital inflammation: report of two cases with a review

Background: Idiopathic orbital inflammation (IOI), also known as orbital pseudotumor, is defined as a nonspecific, non-neoplastic inflammatory process of the orbit without identifiable local or systemic causes. It is a diagnosis of exclusion. Bilateral form is rare. The authors present review of the topic and two cases of bilateral IOI. Methods: The first patient, 35-year-old woman presented with intense swelling of eyelids, started 2 years ago. Noninvasive diagnostic examinations were performed, but no cause of illness was found. Afterwards, biopsy showed sings of idiopathic orbital inflammation. The patient was administered a high dosage of intravenous corticosteroids and then started on a gradually tapering dose of oral corticosteroids. The second patient, 27-year-old woman presented with bilateral proptosis and eyelid swelling, started to years ago. Diagnostic examinations were performed. Biopsy of orbital lesions showed lymphoid type of JOT. Intravenous pulse of corticosteroids followed by oral corticosteroids in gradually lowering doses were introduced. After cessation of therapy, eyelid swelling recurred. Diagnostic procedures were performed again. MRI showed characteristical changes of RN and corticosteroid treatment was reintroduced. Results: First patient showed at 4-month review resolved eyelid swelling, she continued on low doses of oral corticosteroids. The second patient was treated successfully with two pulses of intravenous corticosteroids. 1 month after second pulse we registered reduced eye signs and she continued on low doses of oral corticosteroids. Conclusions: Before immunosuppression is considered, infectious and noninfectious (chemical, neoplastic, vascular, ishemic, and autoimmune) causes of orbital diseases must be ruled out. Long-term treatment with corticosteroids should be considered as a treatment option.