Abstract

Idiopathic orbital inflammatory syndrome (IOIS) is a non-neoplastic, nonspecific inflammatory pathology of the orbit without a known local or systemic cause. It is the third most common orbital disease. It is typically a unilateral disease. We report a case of 76 year old male who presented with complaints of gradual, progressive proptosis, redness and diminution of vision in both eyes for 2 months. He was diabetic and hypertensive. On examination patient had asymmetrical proptosis of 22 and 24mm right and left eye respectively. On slit lamp evaluation severe chemosis and keratinization of the conjunctiva was noted in both eyes. Hirschberg’s test showed 30 degree of left exotropia. There was presence of anterior chamber (AC) reaction and posterior synechiae in right eye, while there was relative afferent pupillary defect (Grade 3) in left eye with a quiet AC. On dilated fundus examination, right eye examination was unremarkable but there was optic atrophy in left eye. MRI orbit showed bulky extra-ocular muscles with thickened tendinous insertions suggestive of IOIS. The optic nerve appeared to be diffusely thickened along its orbital course on left side. Patient was managed with intravenous, oral and topical steroids, cycloplegics as well as lubricants. In a course of 3 months patient had significant reduction in proptosis and improved visual acuity. Due to rarity of anterior uveitis associated with IOIS, we are reporting this case.