Rationale for a diagnostic approach

AbstractPurpose: to propose a diagnostic approach for clinicians who manage a patient with non Graves’ orbital inflammation. Patients&Methods: a review of the diagnostic process for 61 patients with diagnostic of orbital inflammation between january 2002 and january 2013 at Nice and Limoges Universitary Hospitals. Results: sixty one patients presenting with orbital inflammation were included. More common presentations were orbital fat inflammation (60%), myositis (26%) and lacrimal gland enlargement (18%). In few cases, optic nerve and sclera were involved (respectively 9,8 and 3,2%). The final diagnostic was idiopathic orbital inflammation (25 patients), specific orbital inflammation (17 patients) and orbital lymphoma (19 patients). Thirty six patients had biopsy first and 25 patients did not, in first, but only after failure to the initial therapy. Our results showed that doing biopsy in the initial management of orbital inflammation provides a more great number of specific diagnosis than doing treatment tests directly after blood tests or CT scans( p>0,01). Conclusions: The diagnostic process of orbital inflammation must include blood testing, imaging of the orbit and sinuses, and biopsy in first intention as far as possible.