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To evaluate the long-term efficacy of local injection of steroid in treatment of acute idiopathic dacryoadenitis, myositis, and diffuse anterior orbital inflammation.This prospective noncomparative interventional case study included 47 patients with acute idiopathic orbital inflammation. The disease was acute idiopathic 1) dacryoadenitis in 31 patients, 2) myositis in 12 patients, and 3) anterior diffuse orbital inflammation in 4 patients. Betamethasone suspension of 2 to 4 ml (1 ml contains 2 mg betamethasone sodium phosphate and 5 mg betamethasone dipropionate) was injected inside the inflamed gland, around the inflamed muscle and periocular in the diffuse form. Postinjection cold compression was applied for 6 hours, and systemic nonsteroidal anti-inflammatory drugs were given for 2 weeks.Dramatic response was achieved within 7 days after injection in all cases. During the follow-up period up to 8 years, 2 patients (1 with myositis and 1 with diffuse orbital inflammation) had recurrence, which was improved by the second injection.The excellent long-term results achieved will shift the treatment of idiopathic orbital inflammation from oral steroid therapy with its hazards to a safer local injection therapy.