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Intraconal orbital lipoma

Photo by Dr. Yew and Professor Chua

This 60 year-old man presented with a three-year history of bilateral painless proptosis. The proptosis did not progress in the past one year. The ocular movement was full. There was bilateral fat herniation as a result of the proptosis giving both eyes a puffy appearance. The vision was normal in both eyes and he was otherwise in good health. MRI scan revealed bilateral intraconal homogenous masses. The differential diagnosis included orbital lymphoma. Intraconal mass biopsy was performed and the histology revealed only adipose tissue and fat cells without any signs of malignancy. A presumptive diagnosis of orbital lymphoma was made. To improve the eye appearance, bilateral fat excision via lower lid blepharoplasty was arranged in the near future.

 

Bilateral puffy eyelids from fat herniation as a result of the proptosis.   Axial MRI scan shows homogenous intraconal lesion without optic nerve compression.   Coronal MRI of the lesions and the optic nerves.   Another coronal view of the lesions.   Sagittal view of the lesion and the optic nerve.   Biopsy of the right intraconal mass via the medial approach.     The medial rectus is retracted to expose the intraconal space.   Disinsertion of the right medial rectus to reveal the intraconal mass.   Exploration of the intraconal space showed only lipomatous mass.   The intraconal mass was excised for histology.   One of the fragments of excised intraconal mass.   Post-operative appearance.

Atlas of Oculoplastic Surgery