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Abstract
Background: Idiopathic orbital inflammatory disease (IOID) is a diagnosis of exclusion that poses a diagnostic challenge as it may closely resemble other orbital pathologies.
Case report: A 69-year-old woman presented with progressive blurred vision in the left eye associated with pain, redness, proptosis and restricted extraocular movements for 3 weeks. Orbital imaging was suggestive of thyroid orbitopathy, but thyroid function tests were normal. After 8 weeks of medical decompression and oral prednisolone with a suboptimal response, an incisional biopsy of the left lateral rectus muscle revealed non-malignant skeletal muscle with inflammatory cell infiltration, consistent with IOID. Systemic corticosteroid therapy was continued for a total of 16 weeks, resulting in significant improvement in visual acuity, proptosis, and extraocular muscle function.
Conclusion: Given that IOID can mimic orbital pathologies, appropriate imaging and histopathological confirmation are essential for accurate diagnosis. Timely and adequate corticosteroid therapy can lead to favourable visual and functional outcomes.