• encephalocele
• orbital
• varices
• wall defects

Orbital varices are a vascular hamartoma typified by a plexus of low pressure, low flow, thin walled and distensible vessels that intermingle with the normal orbital vessels.^1–4 If freely communicating with the orbital circulation, engorgement of varices can occur by increasing venous pressure through the Valsalva manoeuvre,⁵ bending posture,⁶ coughing or straining and these, in turn, lead to the clinical characteristics of variable proptosis, intermittent pain, and orbital haemorrhage.^7,8

Observation is usually warranted for small lesions, but surgical intervention may be necessary in advanced cases: indications for surgical intervention include non-resolving episodes of thrombosis, severe disfiguring proptosis or displacement of the globe, and optic nerve compression.^1–3 Surgery can be extremely difficult, as varices are very friable and intimately intermixed with normal orbital structures; there is also a significant risk of visual loss as a result of haemorrhage or optic nerve damage, …