What other conditions should you consider in someone with presumed Tolosa Hunt but without significant improvement on steroid therapy?   

It depends on the quality of the pain. If it is burning, itching, or gritty, dry eye should be on the radar. Trigeminal neuralgia is definitely on the table. A good MRI of the orbits with fat saturation, thin slices, and T2 FLAIR axial and coronal will be the most helpful PRIOR to the administration...