"Your diagnosis of bilateral inflammatory pseudotumor of the orbit is a good choice. It apparently is affecting the lacrimal glands and extraocular muscles. It is curious that the left eye has no light perception, but there is a direct pupillary response to light in that eye and there is no optic atrophy.
An incisional biopsy of a lacrimal gland would be a good idea. However, biopsy results do not always reliably differentiate between inflammatory lymphoproliferative disorders and neoplastic ones, such as lymphoma.
If the biopsy is consistent with inflammatory orbital pseudotumor, a trial of systemic corticosteroids would be indicated. If there is no light perception in the left eye, but no optic atrophy, the visual loss might be from compression. Decompression with steroids, radiotherapy or surgical decompression (orbital wall fenestrations) might be considered.
It would be good to get an opinion from our oculoplastic consultants too."