How is orbital inflammatory disease diagnosed
The history and examination should guide further testing. Initial laboratory studies may include a CBC, comprehensive metabolic panel, UA, ESR, CRP, thyroid studies (thyroid-stimulating hormone, T4, antithyroid antibodies including thyroperoxidase, thyroglobulin and thyroid-stimulating antibodies), and ANCAs. MRI of the orbits is commonly obtained to delineate the anatomic structures involved and may allow for discrimination between thyroid eye disease and other causes of OID. A chest radiograph or CT should be considered to rule out concurrent pulmonary involvement from sarcoidosis or GPA. Biopsy is required to rule out infectious and neoplastic etiologies in patients in whom the initial evaluation has not identified a clear etiology. In addition to histologic examination, staining should be performed for fungal and mycobacterial organisms as well as IgG4-specific staining to rule out IgG4-RD.
