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We agree entirely with Dr Coyle that examination of the retina can provide confirmatory clues about the presence of a pigmented orbital mass and even suggest a soft, distensible lesion (it did not in our particular case). Dilated fundus examination is a standard part of the orbital examination. However, orbital imaging studies will better define the precise anatomical location and tissue characteristics of the lesion; in the end, tissue is almost always needed to confirm the diagnosis (excluding, for example, orbital melanoma, which was in the differential diagnosis of our reported case).
Goldberg RA, McCannel CA, Weinberg DA, Glasgow BJ. Hemorrhage Into an Infraorbital Pseudocyst-Reply. Arch Ophthalmol. 1997;115(8):1085. doi:10.1001/archopht.1997.01100160255027