A Possible Association Between Gluten Sensitivity and Idiopathic Orbital Inflammation: A Case Report

Idiopathic orbital inflammation (IOI) is a non-infectious orbital disorder with presumed immune-mediated mechanisms. Non-celiac gluten sensitivity (NCGS) is a clinical syndrome characterized by gluten-induced symptoms in individuals without celiac disease (CD) or wheat allergy. Both conditions lack definitive biomarkers and share unclear etiopathogenesis. This case explores a potential link between IOI and NCGS, suggesting dietary gluten as a possible trigger for orbital inflammation. A 31-year-old woman presented with recurrent unilateral orbital inflammation and chronic gastrointestinal symptoms. Orbital imaging showed lateral rectus muscle involvement without a detectable mass. Laboratory tests excluded autoimmune disease, CD, and wheat allergy. After four episodes over two years, a strict gluten-free diet (GFD) was initiated, resulting in complete remission of both orbital and gastrointestinal symptoms for three years. Following accidental gluten ingestion, the patient experienced abdominal discomfort followed by recurrent orbital inflammation. Symptoms resolved with corticosteroids. Although a double-blind placebo-controlled gluten challenge was recommended, it was declined due to fear of recurrence. This case suggests a possible association between gluten sensitivity and IOI. The clinical improvement with a GFD, and relapse following gluten exposure, support this link. Further studies are needed to investigate the immunological relationship between gluten-related disorders and orbital inflammation.