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July 2004

Idiopathic Orbital Inflammatory Disease—Reply

Arch Ophthalmol. 2004;122(7):1092-1093. doi:10.1001/archopht.122.7.1092-b

In reply

In a disorder as perplexing in its etiology and frustrating in its managementas idiopathic orbital inflammatory disease, we welcome any insights and recommendationsregarding therapeutic options. Goldberg et al raise the possibility of orbitalsteroid injections and kindly present their technique and rationale (lesssystemic delivery of steroid compared with oral administration). We were unawareof prior publications addressing the use of orbital injection of steroidsfor this disorder. Our past reluctance can be further attributed to our knowledgeof high injection pressures associated with intralesional injections1 and fears of potential blinding embolic complicationsassociated with intraorbital injection of steroids.2 Wehave also managed several patients referred with non–sight threateningcomplications attributed to repeated orbital injection of steroids, includingorbital fat hypertrophy with herniation into the eyelids and large xanthelasmaof the eyelids (Figure 1). Orbitallipomatosis complicating orbital steroid injection has also been reported.3,4