A 60-year-old man presents with painless progressive proptosis, non-pulsatile, with resistance to retropulsion. MRI shows a well-defined homogeneously enhancing extraconal mass in the superior orbit with 'moulding' around the globe. The MOST likely diagnosis is:

• A Cavernous haemangioma of the orbit
• B Orbital pseudotumour (idiopathic orbital inflammatory syndrome)
• C Metastatic carcinoma to the orbit
• D Orbital lymphoma ✓

Explanation

Orbital lymphoma classically presents in elderly patients as a painless, slowly progressive proptosis. It is typically extraconal, moulds to the globe (a hallmark), and shows homogeneous enhancement. B-scan shows high internal reflectivity. Cavernous haemangioma is usually intraconal, encapsulated, and most common in middle-aged women. Orbital pseudotumour is painful and rapidly progressive. Metastatic disease often produces enophthalmos (breast) or less well-defined infiltration.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.