Orbital pseudotumor

Discussion:

Right orbital pseudotumor with pre-orbital cellulitis.

Orbital pseudotumor is an idiopathic inflammatory lesion of the orbit most commonly involving the extra-ocular muscles (most commonly the lateral rectus muscle), but can involve any of the orbital contents including the retro-orbital fat and the lacrimal gland.

The differential diagnosis of orbital pseudo-tumor of the orbit is:

  • Thyroid orbitopathy (Grave's disease):  usually sparing the anterior tendon of the extra-ocular muscles and is limited to the muscle belly. The inferior and medial rectus muscles are commonly involved followed by the superior and lateral rectus & oblique muscles (I'M SLOw!)
  • Orbital lymphoma: homogeneously enhancing intraorbital mass usually separable from the extra-ocular muscles. Painless swelling with proptosis.
  • Tolosa-Hunt syndrome: the orbital inflammatory lesion involves the orbital apex with extension into the cavernous sinus.
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