Advances in diagnosis, treatment, and management of orbital and periocular Wegener's granulomatosis.

Ophthalmologists are often in a position to diagnose Wegener's granulomatosis and prevent significant morbidity. The past 2 years have seen advances in diagnosis and management strategies for this condition. Orbital magnetic resonance imaging and histologic profiles have been better characterized. Perhaps the greatest advance has been the recognition of promising therapeutic alternatives to the current standard cytotoxic protocol. Trimethoprim-sulfamethoxazole or methotrexate may be valuable in selected patients with limited forms of Wegener's granulomatosis. Finally, new insights into the mechanisms of disease activation and tissue injury may lead to better treatment and long-term prognosis.