How is orbital inflammatory disease treated
The treatment of OID depends on the etiology of the underlying condition. Patients with rheumatologic conditions such as GPA causing OID are commonly treated with similar medications used for extraocular organ involvement (such as high-dose steroids, methotrexate, azathioprine, rituximab, or cyclophosphamide in the case of ANCA-associated vasculitis). Patients with sarcoidosis may have concurrent OID that is relatively mild in nature and warrants observation alone. More significant involvement may be treated with corticosteroids, methotrexate, azathioprine, or infliximab. Patients with IgG4-RD and OID may be treated with corticosteroids, with rituximab reserved for resistant disease, those failing steroid therapy, or patients with significant extraocular disease involvement.
The treatment of thyroid-associated ocular disease is beyond the scope of this chapter, but commonly includes reversal of hyperthyroidism if present (through oral medications and/or consideration of thyroidectomy), corticosteroids (including high-dose pulse intravenous therapy at onset), and complete cessation of tobacco use by the patient if applicable. In patients with sight-threatening disease, orbital decompression may be considered. Orbital radiation can be used in steroid-resistant cases, but its use may be limited by toxicity (risk of retinal and optic nerve damage). Steroid-sparing immunosuppression with rituximab and mycophenolate mofetil have mixed results in the literature, with newer data showing promising results with a monoclonal antibody against insulin-like growth factor-1 (teprotumumab).
