Orbital Biopsy


The orbit may be biopsied to diagnose inflammations including infections, and neoplasms. The age of the patient, the presenting symptoms, and imaging studies should allow the ophthalmologist to construct a differential diagnosis. The differential diagnosis, in turn, will assist the ophthalmologist in handling the biopsy tissue to take maximum advantage of the partnership with the pathologist in rendering an accurate and timely diagnosis.

Embryonal rhabdomyosarcoma from the orbit of a young child.


Preparation by Ophthalmologist

Suspected infections

  1. Have culture media on hand and be certain that the microbiology laboratory is aware of the impending arrival of the biopsy sample

Suspected lymphoma

  1. Tissue should be placed in fixative for permanent sections (please check with the laboratory for the preferred fixative of choice for suspected lymphomas).
  2. Fresh tissue should be sent to the immunopathology laboratory for flow-cytometry and/or immunohistochemistry. In general, we find that immunohistochemistry on fresh material is superior to that which can be obtained from fixed material. Material which is frozen can also be analyzed by molecular pathology techniques.

Suspected rhabdomyosarcoma

  1. Please alert the laboratory in advance so that the tissue may be processed in a rapid cycle. Immunohistochemistry may be performed on formalin-fixed tissue.
  2. Be sure to sample viable tissue. If the ophthalmologist samples friable tissue only, and the tumor is necrotic, it may be difficult to render a diagnosis.

Other neoplasms

  1. Immunohistochemistry may be required to determine the histogenesis. If the patient has a known primary lesion, and the ophthalmologist suspects a metastasis to the orbit, please contact the laboratory in advance of the biopsy for possible special instructions in handling tissue.

About frozen sections

  1. At the University of Illinois at Chicago (UIC), frozen sections from orbital tissue are performed in limited circumstances to
    1. Identify the presence of mucormycosis
    2. Asssess the margins of resection
    3. Determine if representative tissue has been obtained
  2. Only in very special circumstances will a diagnosis be rendered on frozen section material from orbital biopsies before consulting with permanent sections and marker studies.

Preparation by Ophthalmic Histotechnologist/Cytotechnologist

Suspected orbital lymphomas should be processed specially according to guidelines for handling lymph nodes.


Issues for the Pathologist


In addition to the ophthalmologist's differential diagnosis, the pathologist can build a differential diagnosis based upon the age of the patient. Certain neoplasms tend to occur in children; others in adults. For example, lymphoma of the orbit seldom occurs in children (outside of the the context of Burkitt's lymphoma).


More Questions?

If you have more questions about orbital biopsy specimens, please contact one of us:

Ophthalmic Pathologists

Robert Folberg, MD, FCAP, Director

Deepak P. Edward, MD

Consultation Coordinator

Marnie Pomeroy





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