Treatment protocol for orbital inflammatory disease

Forty-five consecutive patients suspected of having orbital inflammatory disease (OID) were treated according to a protocol that provided specific dosages of steroids and a formula of dose reduction. Nonresponsive cases were managed with intravenous dexamethasone and, when brought under control, were switched to oral therapy. The cases that continued to be unresponsive or escaped from control were biopsied. If the frozen section was read as inflammatory, intralesional steroid was injected. For resistant or recurrent cases, 1000-3000 rads of orbital irradiation were delivered in fractionated doses. For extreme cases, radiotherapy was combined with steroids and chemotherapy (cyclophosphamide). Twenty-nine patients improved with steroids alone, four with additional intralesional steroid injections, six with radiotherapy, and two required both radiotherapy and chemotherapy.