A 47-YEAR-OLD woman experienced the sudden onset of pain, proptosis, and visual loss in the right eye. On examination she had a visual acuity of hand motions OD, 4 mm of axial proptosis, and 6 mm of upward displacement of the right globe (Figure 1). On upgaze, a purplish mass was visible in the lower fornix. A change in the size of the mass could not be elicited by Valsalva maneuver or dependent positioning. Fundus examination revealed retinal striae (Figure 2). A magnetic resonance imaging scan showed a smoothly marginated mass in the inferior orbit, flattening the right globe and displacing the optic nerve (Figure 3). Just inside the margins of the mass was a high–signal–intensity band, suggesting recent internal hemorrhage. Magnetic resonance angiography did not show dilation of orbital veins, feeder vessels, or other evidence of systemic vascular communication. Because of the patient's age and acute presentation, intralesional hemorrhage into an orbital varix or lymphangioma was strongly considered in the differential diagnosis.
Kim JW, Stewart WB, Spencer WH, Ellis DS. Acute Expansion of an Orbital Vascular Malformation. Arch Ophthalmol. 1999;117(6):844-845. doi:10.1001/archopht.117.6.844