How do you approach diagnosis and management of orbital myositis?

Orbital myositis is an umbrella diagnosis that includes a wide range of potential underlying conditions. Patients with this presentation are often first evaluated by neuro-ophthalmology to exclude causes such as isolated orbital myositis, myasthenia gravis, thyroid eye disease, infection, and diabetic mononeuropathy, among others. These cases typically require a multidisciplinary approach, and patients are frequently referred to rheumatology for evaluation of potential systemic autoimmune or inflammatory diseases.

From a rheumatologic perspective, the differential diagnosis includes systemic conditions commonly associated with ocular involvement, such as sarcoidosis, vasculitis, IgG4-related disease, and systemic lupus erythematosus. Orbita...