Figure 12.15 A non-inflamed eye with almost complete (but reversible) loss of eye movements and periorbital sensory impairment, due to orbital inflammation at the superior orbital fissure: (a) right gaze, (b) left gaze, (c) upgaze, (d) downgaze.
formed specimens are much more readily interpreted than those taken by aspiration needle biopsy; needle biopsy should, therefore, probably be used only for sampling lesions in patients with known carcinomatosis, in whom confirmation of a likely orbital metastasis is required prior to radiotherapy.
Treatment after biopsy is aimed at suppressing the inflammatory response with systemic corticosteroids or radiotherapy. In most instances, there is a good response to prednisolone 60-100mg per day (or lmg/kg/day) and the dosage should be reduced towards 20mg daily within 3-4 weeks and more slowly thereafter. Radiotherapy to the retrobulbar tissues (generally 2000-2400cGy, in fractionated doses of 200cGy) may be valuable where there is a poor response to steroids, or where it is not possible to reduce the dosage to an acceptable level. Cytotoxic agents, such as cyclophosphamide, cyclosporin or methotrexate, have been used in recurrent and steroid-resistant orbital inflammation.
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