An 8-year-old boy presents with one week of rapidly progressive left proptosis with eyelid swelling and downward displacement of the globe. He is afebrile. Imaging shows a solid superonasal orbital mass. What is the next best step?

• A Start broad-spectrum antibiotics and observe for 48 hours
• B Immediate orbital exenteration
• C Fine needle aspiration cytology followed by observation
• D Urgent incisional biopsy of the mass ✓

Explanation

Rapidly progressive proptosis in a young child is rhabdomyosarcoma until proven otherwise; it is the most common primary malignant orbital tumour of childhood. Diagnosis requires urgent incisional biopsy, after which chemotherapy and radiotherapy are given. Observation delays a curable malignancy. Exenteration is obsolete as initial management because combined therapy achieves good survival. Afebrile status helps separate it from orbital cellulitis.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.