Granulomatosis with polyangiitis presenting as anophthalmic socket pain

Ocular and orbital symptoms are among the most common presenting signs in granulomatosis with polyangiitis (GPA). This report describes a patient with bilateral anophthalmos presenting with several weeks of left socket pain that was unresponsive to analgesics and low-dose oral steroid, without periorbital inflammation or orbital lesions on imaging. She was initially diagnosed with orbital neuralgia secondary to extensive prior orbital fractures and hardware and was scheduled for hardware removal. While awaiting surgery, she was admitted 1 month later for pneumonia and was diagnosed with GPA following an extensive systemic work-up. After commencing systemic treatment for the GPA, her left socket pain resolved. Therefore, GPA should be considered in the differential diagnosis of anophthalmic socket pain, even without periorbital inflammation or orbital lesions.