Orbital inflammation: Biopsy first

Orbital inflammation is a response of the immune system and not a diagnosis in itself. Exposing the underlying disease introduces a labyrynthine challenge owing to the broad array of possible causes ranging from infectious, structural, autoimmune, idiopathic to neoplastic origin. In this regard, and despite its unkown etiology, idiopathic orbital inflammation (IOI) intrinsically is a genuine diagnostic entity. Where clinical and radiological findings of an orbital inflammatory mass are inconclusive, pathological examination of the tissue biopsy—obtained by minimally invasive approach and local anesthesia—is advocated to work towards a diagnosis in a most timely and effective manner. A corticosteroid response can be observed in most orbital disorders with lymphocytic components, including IOI, and, accordingly, constitutes a paradoxical and weak tool to identify the diagnosis in orbital inflammation.