To evaluate the efficacy of intravenous methylprednisolone pulse therapy in patients with idiopathic orbital inflammation.

Fifty-two patients who received three-day pulse methylprednisolone for acute severe swelling, loss of visual acuity, limitation of eye movement, diplopia, or pain were included in the present study. The lesions were divided into five subtypes using computed tomography or magnetic resonance imaging; anterior, lacrimal, myositic, diffuse and apical. A case diagnosed as sclerotic type was excluded. The response rate, recurrence rate and cure rate were assessed.

The total response rate to intravenous methylprednisolone from all groups was 84.6%, with 100% in the anterior subtype and 71.4% in the diffuse subtype. During the mean follow-up period of 10.5 months, 15.9% of patients experienced a recurrence after a mean of 5.7 months. Overall, the cure rate was 71.2%. Recurrence was more common in the younger patients, and three of the seven patients with recurrence had myositic inflammation.

Intravenous methylprednisolone was effective in patients with severe idiopathic orbital inflammation. However, combining other treatment modalities in patients with diffuse or myositic subtypes and in younger patients who show relatively low response or high recurrence is recommended.