Management of orbital inflammatory disease. A protocol.

A step-by-step practical approach to orbital inflammatory disease is presented. In our hands, this proposed protocol has been useful. In any patient with orbital inflammatory disease, the ophthalmologist must initially rule out a life-threatening bacterial orbital cellulitis. Because the orbital disease presentation may be part of a systemic process, a good history and appropriate systemic work-up are mandatory. If any suspicion of bacterial orbital cellulitis exists, we recommend that intravenous antibiotics be instituted. Concurrently, orbital computerized tomographic scan may be extremely helpful in the work-up. Specifically, three findings--presence of an orbital-mass lesion without sinus involvement or bone erosion, presence of an orbital-mass lesion with sinus involvement or bone changes, or thickened extraocular muscles on CT scan--lead to the differential diagnosis, decision to biopsy, and appropriate treatment.