title: Role of antimetabolites in recalcitrant idiopathic orbital inflammatory syndrome.
abstract: BACKGROUND
  High-dose systemic steroids are the primary modality of treatment for idiopathic orbital inflammatory syndrome (IOIS). Occasionally patients experience a relapse of symptoms on tapering steroids or require large doses of steroid, predisposing them to the adverse effects of steroids.
  
  
  OBJECTIVE
  We present our experience with the management of three patients with recalcitrant IOIS, with immunosuppressive therapy, using antimetabolites.
  
  
  METHODS
  A retrospective review of the medical records of the patients being reported.
  
  
  RESULTS
  Two patients were treated with Methotrexate and one with Azathioprine for a duration of 6-24 months. Two patients were symptom-free three years after stopping the medication. One was doing well clinically with methotrexate therapy alone, when he was lost to follow-up after six months. No adverse effects of immunosuppressive therapy were encountered.
  
  
  CONCLUSIONS
  High-dose systemic steroid therapy is the first-line treatment for IOIS, but in refractory or steroid-dependent cases, immunosuppressive therapy with antimetabolites is a safe and effective treatment alternative to steroids. However, treatment with antimetabolites warrants close monitoring for complications like bone marrow suppression and liver dysfunction, especially because long-term treatment is required.
authors.affiliation: Department of Ophthalmology, St John's Medical College Hospital, Bangalore - 560 034, India.
authors.forename: Yamini
authors.initials: Y
authors.lastname: Priya
authors.forename: Suneetha
authors.initials: S
authors.lastname: Nithyanandam
authors.forename: Manjoo S
authors.initials: MS
authors.lastname: Reddy