Non-specific Orbital Inflammation of Sinonasal Origin

Area of Science:

• Ophthalmology
• Immunology
• Otorhinolaryngology

Background:

• Non-specific orbital inflammation (NSOI), or orbital pseudotumor, is a common orbital disease with poorly understood pathogenesis.
• While immune dysregulation is suspected, NSOI coexisting with chronic rhinosinusitis with nasal polyps (CRSwNP) is rarely reported.

Purpose of the Study:

• To investigate potential pathophysiological links between NSOI and CRSwNP.
• To evaluate treatment outcomes in patients with coexisting NSOI and CRSwNP.

Main Methods:

• Retrospective analysis of 34 NSOI patients (2014-2024) at Medical University of Bialystok.
• Seven patients (20%) had coexisting CRSwNP, diagnosed via orbital biopsy and exclusion of systemic disease.
• Evaluated symptom onset, bacteriology, inflammatory markers, imaging, and histopathology.

Main Results:

• Orbital symptoms followed sinonasal symptoms and surgery in all CRSwNP cases.
• Evidence suggested a mixed type 2/type 3 inflammatory endotype with eosinophilia and bacterial infection signs.
• Imaging showed orbital wall defects with osteogenesis; histopathology revealed fibrosis.
• Corticosteroids provided partial stabilization; immunosuppressants or radiotherapy were needed for some. No complete remission was achieved.

Conclusions:

• Chronic rhinosinusitis may trigger or exacerbate NSOI in individuals with immune dysregulation.
• Advanced fibrotic stages showed poor response to standard treatments.
• Tailored, multidisciplinary approaches and further research into NSOI pathogenesis are needed.