Orbital pseudotumor, also known as idiopathic orbital inflammatory disease (IOID), is an idiopathic inflammatory process within the orbit. The potential for permanent visual impairment makes this disease important to diagnose and treat. While oral corticosteroids are the mainstay of therapy, they can have significant toxicity when used for long periods of time. We present a case of IOID that was successfully treated with leflunomide after methotrexate was discontinued for toxicity-related issues. To our knowledge, use of leflunomide for this condition has not previously been reported in the literature.