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A 62-year-old lady presented with a large, right-sided orbital mass. It started as a small mass in the right lower lid 4 years back, which slowly grew in size. At presentation, she had no perception of light in the right eye. On examination, there was a 40×60 mm multilobulated intraorbital mass, causing massive proptosis and upward displacement of the globe. There was marked stretching and thinning of both the upper and lower lids and widening of the horizontal palpebral aperture. The tumour had a bluish colour at places and prominent vessels that were evident through the thinned out lids. The overlying skin was normal. On palpation, there was no tenderness or pulsations. The cornea was hazy precluding optimal posterior segment examination. The left eye had corneal opacity with cataract. The draining lymph nodes were not enlarged.
CT and subsequent MRI of the orbit were done (figure 1A–C). Fine needle aspiration for cytology revealed serosanguineous fluid. Preoperatively, we aspirated 20 ml of serosanguineous fluid from the tumour, thus decompressing it. The tumour was excised piecemeal via anterior orbitotomy. As the orbital walls were extremely thinned out on imaging, we did not attempt to dissect the tumour from the periorbita that appeared to be intact even in areas of herniation. Therefore, some residual tumour was left behind. Excess of lid tissue was resected. Intraoperatively, we found large tortuous blood vessels within the tumour. Histopathological findings were diagnostic (figure 2).