title: The role of biopsy in diagnosing patients suspected of idiopathic orbital inflammation.
abstract: OBJECTIVE
  To provide a framework when to biopsy patients suspected of idiopathic orbital inflammation (IOI).
  
  
  METHODS
  One-hundred seventeen patients were selected with signs of orbital inflammation in whom after history and physical examination, no definite diagnosis was made. In this cohort, the role of biopsy in making a diagnosis was evaluated and compared to a therapeutic trial of corticosteroids.
  
  
  RESULTS
  In 67 of 117 patients, a diagnosis was evident after imaging and laboratory testing. In 50 remaining patients, a decision had to be made to biopsy or administer a therapeutic trial of corticosteroids. Thirty-nine patients underwent biopsy as the next step. Nine patients underwent a therapeutic trial of corticosteroids of which one was subsequently subjected to biopsy. Two patients spontaneously resolved. No patients with a malignancy were inadvertently treated with corticosteroids. One patient experienced a biopsy related complication but did not lose vision.
  
  
  CONCLUSIONS
  This study suggests using a therapeutic trial of corticosteroids only in patients with low suspicion of malignancy with muscular and apical mass localizations, or with optic-nerve compression. This framework was demonstrated to be safe in not delaying diagnosis of malignancies and efficient in providing a rapid diagnosis.
authors.affiliation: University Medical Center Utrecht, Department of Ophthalmology, Heidelberglaan, CX Utrecht, The Netherlands. w.r.bijlsma@umcutrecht.nl
authors.forename: Ward R
authors.initials: WR
authors.lastname: Bijlsma
authors.forename: Niels J
authors.initials: NJ
authors.lastname: Elbert
authors.forename: Rachel
authors.initials: R
authors.lastname: Kalmann
mesh_terms: D000465:Algorithms; D001706:Biopsy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D009915:Orbit / Q000473:pathology*; D016727:Orbital Pseudotumor / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D005938:Glucocorticoids