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Conjunctival Melanoma Two darkly pigmented patients with a diagnosis of conjunctival melanoma by an outside provider are presented here. Case 1 presented with a large jet black conjunctival lesion that was present for nearly 12 years. This lesion was biopsied by an outside provider and interpreted …

Orbital Sarcoidosis A patient presented with three months of left eye swelling and pain. He was found to have periorbital firmness and fullness, proptosis, and conjunctival chemosis. He underwent computed tomography imaging of the orbits with contrast, which demonstrated an ill-defined, irregular a…

Orbital Metastatic Breast Cancer A patient presented to the ER with redness of the right eye for months. Initial exam revealed VA 20/50 and was noted to have right sided ptosis and ophthalmoplegia. MRI of the orbits was performed which showed an ill-defined right orbital mass. The patient underwent…

Adenoid Cystic Carcinoma A patient with past medical history of a previously resected lacrimal gland mass presented to the emergency room with worsening unilateral proptosis and eye pain with persistent new eversion of the upper eyelid for several days. Examination was significant for severe propto…

Adenoid Cystic Carcinoma of the Lacrimal Gland A 43-year-old female presented to her primary care physician with swelling of the lateral aspect of the right upper eyelid without visual complaints. The primary care physician noted proptosis of the right globe and ordered a CT scan which revealed a m…

Alveolar Rhabdomyosarcoma A patient presented to BPEI for evaluation of a left upper lid lesion present since birth with no improvement with conservative treatment. Examination revealed a firm, blue, red lesion involving the upper left eyelid and lower eyelid. MRI orbit imaging revealed extensive s…

Histopathology and radiographic images of rhabdomyosarcoma in a young infant.

Carcinoma Ex Pleomorphic Adenoma A 76-year-old female referred by primary care physician for right eye proptosis. The patient complained of diplopia for the last six months without associated pain or irritation. External exam was significant for proptosis of the right eye and hypoglobus. Visual acu…

Enophthalmos Due to Metastatic Orbital Breast Carcinoma A patient presented to the ER with subconjunctival hemorrhage but incidentally noted to have enophthalmos with mild extraocular movement restriction in the contralateral eye. Further history revealed breast cancer history that was treated 18 y…

Extranodal Marginal Zone Lymphoma 52-year-old male with Stage IV extranodal MALT lymphoma who initially presented with paranasal and perioribtal disease. He failed treatment with multiple chemotherapeutic agents and represented with decreased VA 20/40 and 20/80 thought to be due to diffuse choroida…

Granular Cell Tumor The patient presented to BPEI for evaluation of a two-week history of worsening diplopia. Examination revealed left unilateral proptosis. MRI orbit imaging revealed an intraorbital well-defined, well-circumscribed lesion arising at the level of the medial rectus. The patient und…

The patient presented with an enlarging lower eyelid lesion for 2 months. There was irregular pigmentation without ulceration or madarosis. Biopsy confirmed an intradermal nevus.

Orbital Venous Lymphatic Malformation A patient presented to the ER complaining of 2 days of increasing pain and swelling behind the left eye. Of note the patient reported that as a teenager he was previously treated for an orbital tumor. On exam he was found to have massive proptosis, hyperglobus …

A patient with orbital venous lymphatic malformation causing massive proptosis. MRI demonstrates an enhancing, T1 hypointense, T2 hyperintense, lobulated mass with small blood-fluid levels in the left medial orbit compressing the globe and causing bony deformation of the bony orbit. Surgical specim…

Sebaceous Carcinoma, Concern for Muir-Torre Syndrome Our patient presented with a greater than one year history of a non-resolving right eyelid mass that began to hemorrhage due to accidental trauma. Exam was remarkable for and extensive multi-lobar ulcerated mass found along the right lower lid al…

Squamous Cell Carcinoma, Metastatic Prostatic Adenocarcinoma A 77-year-old Caucasian male with a history of locally advanced prostate cancer on androgen deprivation therapy presented to BPEI for evaluation of a right lower lid lesion present for six weeks that did not improve with conservative trea…

Orbital Necrotizing Fasciitis A patient found down by EMS with left orbital swelling for 2 days after he was unable to take his medications due to a recent illness. He was admitted to a hospital and treated for diabetic ketoacidosis, Group A Streptococcus sepsis and left orbital infection before pr…

Aneurysmal Bone Cyst A patient with a 2-week history of proptosis and vision changes in the right eye is transferred from an outside hospital. Neuroimaging revealed a large intraorbital and intracranial expansile lesion with multilobulated cystic spaces, surrounded by a thin cortical shell with per…

NUT Carcinoma A patient presented with several weeks of right eye proptosis. On initial examination, his visual acuity in the right eye was 20/400, and a relative afferent pupillary defect was noted. He had 4 mm relative proptosis on the right and restricted motility in all gaze directions. CT orbi…

Orbital Lympathic Dominant Lymphatic Venous Malformation A patient with a past ocular history of orbital lymphatic-venous malformation with left upper eyelid swelling and proptosis at childhood who underwent sclerosing therapy presents 7 years later with newly developed left upper eyelid swelling, …