Four tips help avoid pitfalls of ocular inflammation

New Orleans-Geoffrey Rose, FRCOphth, from London, offered four key points for managing patients with ocular inflammation.

First, and most importantly, he emphasized, orbital inflammation is a tissue response and not a diagnosis. Dr. Rose spoke at the annual meeting of the American Academy of Ophthalmology.

Orbital inflammation is caused by an abscess or a foreign body, a leaking dermoid, an unusual organism, a hematological malignancy, a solid tumor undergoing necrosis, and a non-infective vasculitis, or the inflammation may be idiopathic. Thus, determining the cause of the inflammation determines the appropriate treatment.

Second, the term pseudotumor is a dangerous anachronism and not a diagnosis.

"This term should not be used. When you encounter this patient, think that the patient has idiopathic inflammation and keep your mind open to the cause of the inflammation," he stated.

Third, the empirical use of steroids is unjustified.

Fourth, almost all infiltrative orbital lesions should be biopsied, except for two scenarios, orbital myositis or orbital apex syndrome.

"Orbital myositis and orbital apex syndrome have very characteristic histories, clinical signs, imaging studies, and therapeutic responses. The risks of a biopsy are somewhat higher than the risk of missing an underlying diagnosis," he said.