title: [Rationale for a diagnostic approach in non-Graves' orbital inflammation--Report of 61 patients].
abstract: BACKGROUND
  Orbital inflammatory syndromes include a wide variety of inflammatory intraorbital processes which are very different in terms of clinical presentation and prognosis. We currently prefer to differentiate so-called "specific" inflammations, for which an etiology is able to be identified, from idiopathic orbital inflammatory syndromes (IOIS), for which the etiology remains unknown and the histology is nonspecific.
  
  
  OBJECTIVE
  To propose an efficient diagnostic approach for clinicians managing patients with non-Graves' orbital inflammations.
  
  
  METHODS
  This is a retrospective and prospective study concerning 61 patients managed by the medical team for non-Graves' orbital inflammations between May, 1999 and May, 2013 in the ophthalmology departments of Nice and Limoges university hospitals in France. Seventeen specific inflammations, 19 orbital lymphomas and 25 idiopathic orbital inflammatory syndromes were included. Patients were divided into two groups. Thirty-six patients (group 1) underwent primary biopsy, while for the other 25 (group 2), therapy was begun empirically without biopsy. We could therefore compare both approaches in terms of diagnostic efficiency and time until identification of a specific etiology.
  
  
  RESULTS
  Our statistical results show that an approach without primary biopsy leads to a number of specific diagnoses statistically much lower than that obtained by the approach with primary biopsy. Also, the risk of missing a specific inflammation (with as a consequence an inappropriate treatment and a risk of functional sequelae as well as a fatal risk of missing a lymphoproliferative pathology) is very clearly higher in the case of not performing primary biopsy. Finally, the average time elapsed between the initial consultation with the ophthalmologist and a specific diagnosis was one month in the case of the first approach, while this delay was almost three times higher with the second approach, with a mean of 2.91 months (P<0.01).
  
  
  CONCLUSIONS
  Our study shows that biopsy should be the mainstay of diagnostic management. A trial of empiric treatment is only performed first in myositis or in locations where biopsy could jeopardize functional prognosis. It should only be done after biopsy in all other cases. Of course, in all cases of relapse or recurrence after treatment, biopsy should be performed or repeated.
  
  
  CONCLUSIONS
  The diagnostic work-up of a patient with an orbital inflammatory process must of course include blood testing and orbital imaging, but also a systematic primary biopsy for histological examination in the vast majority of cases. It must be repeated at least in the case of any doubt about the diagnosis or in the case of any recurrence or resistance to treatment.
authors.affiliation: Ophtalmologie pédiatrique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France. Electronic address: alexgavard@yahoo.fr.
authors.forename: A
authors.initials: A
authors.lastname: Gavard-Perret
authors.affiliation: CHU de Nice, 30, voie Romaine, 06001 Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Lagier
authors.affiliation: CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
authors.forename: J
authors.initials: J
authors.lastname: Delmas
authors.affiliation: CHU de Nice, 30, voie Romaine, 06001 Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Delas
authors.affiliation: CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Adenis
authors.affiliation: CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
authors.forename: P-Y
authors.initials: PY
authors.lastname: Robert
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D003607:Dacryocystitis / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D003663:Decision Trees; D003951:Diagnostic Errors / Q000517:prevention & control; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D007249:Inflammation; D008223:Lymphoma / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D018442:Lymphoma, B-Cell, Marginal Zone / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D055622:Orbital Myositis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D009918:Orbital Neoplasms / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents
keywords: Biopsie orbitaire; Corticothérapie; Idiopathic orbital inflammation; Inflammation orbitaire idiopathique; Lymphome orbitaire; Orbital biopsy; Orbital lymphoma; Orbitopathie inflammatoire spécifique; Specific orbital inflammation; Steroid treatment