Abstract
Purpose :
To evaluate the utility of laboratory tests, imaging modalities, and histopathologic analysis in contributing to the final diagnosis and management of orbital inflammatory conditions and to assess the cost-benefit ratio of standard testing strategies across different institutions.
Methods :
Retrospective analysis of patients who have undergone standard laboratory testing in the evaluation of orbital inflammation at Oregon Health & Sciences University (OHSU), University of Montreal, and University of California at San Francisco. Test performance will be calculated for all diagnostic testing by determining each test result’s relationship with the final diagnosis. For non-binary tests, the laboratory reference range will be used to determine what is considered abnormal.
Results :
Our cohort demonstrated a female predominance (66.5%) in the fifth to seventh decade of life (60.2%). The most common presenting symptoms were pain (61.5%) and eyelid edema (56.5%). Radiographic findings of the orbit demonstrated involvement of the extraocular muscles (39.8%), orbital fat (24.2%), and lacrimal glands (43.5%) most commonly. After extensive laboratory and histopathologic analysis, 28.6% of patients were diagnosed with an underlying etiology of orbital inflammation. Of these patients, 54.3% underwent laboratory testing that contributed to this diagnosis. The labs that contributed most to the final diagnosis were IgG4 (26.2%), ESR (18.8%), CRP (16.9%), TSI (13.3%), and lysozyme (10.7%). Based on OHSU laboratory pricing, the cost of these tests until they contributed to the diagnosis were $320.25 (IgG4), $208 (ESR), $580.50 (ESR), $1365 (TSI), and $1017.33 (lysozyme).
Conclusions :
There is lack of consensus on the diagnostic criteria for idiopathic orbital inflammatory disease primarily due to the variability of its clinical presentation. It is typically considered a diagnosis of exclusion, involving laboratory and histopathologic evaluation for underlying systemic conditions. This study is the first to evaluate the cost-benefit ratio of standard testing procedures and their diagnostic yield in the context of orbital inflammatory conditions. Unfocused testing is costly and may be difficult to interpret or lead to improper or under treatment. It is important for clinicians to consider a targeted laboratory and radiographic work up in the evaluation of patients with orbital inflammation.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.