Atypical inflammatory lesions in the orbit and adnexae

Abstract

Abstract Purpose The common use of an initial systemic steroid treatment trial in orbital and adnexal inflammatory disease is now more questionable and used less frequently. The increased availability of specialized oculoplastic and orbital surgeons has enabled us to biopsy masses of the orbit routinely in recent years. As a result unusual pathology appears more commonly than expected in previous years. We reviewed the diagnosis and presentation of unusual inflammatoty lesions of the orbit biopsied over the past 8 years in our oculoplastic and orbital clinic. Some interesting representative cases are presented. Methods A search of the operation register and recorded diagnosis of pathology specimens was carried out and a retrospective review was made of all patients with unusual orbital inflammatory lesions presenting at the oculoplastic surgical service in Meir Medical Center between 1999 and 2008. All cases had CT imaging of the orbits and underwent biopsy of the lesion. Pathology examination was performed on all specimens following biopsy. Results There were 5 cases of non caseating granulomas in the Orbit, 1 case of Churg Strausse syndrome, 2 cases of lymphoid hyperplasia, 1 case of infectious mononucleosis dacryoadenitis, 2 cases of Eosinophillic Granuloma, 1 case of malignant schwannoma, 2 cases of angiolymphoid hyperplasia, 1 case of Sclerosing type idiopathic orbital inflammatory disease and 1 orbital abscess with an unusual presentation Conclusion We recommend biopsy of all orbital inflammatory masses before beginning treatment with steroids. Unusual pathology is more likely than expected and may have significant implications for the well being of patients.