This 17-year-old girl was noted by her parents to have bulging of her right eye beginning about 5 years ago. This bulging occurred when she was prone or when she bent her head over for a few minutes as shown in the picture below. Prior to this she was perfectly normal. Early on it took a “considerable period” of time in prone or bent over position for the bulging to occur, but it happens now in only a few minutes, even when she has her head bent over while studying.

Upon examination, proptosis along with fullness of the upper lid was noted after bending over for 30 seconds. This proptosis subsided almost immediately when the girl’s head was upright. The girl denies any pain or discomfort. Vision is 20/20 in each eye unaided and the remainder of the eye examination is normal and her health is otherwise good.

25 comments

  1. If its really a haemangioma, how ll you do it confirm? than for how long would you keep this case for observation or for what management?

    1. Hemangioma would be expected to enhance with contrast in imaging since it is vascular. The only method to absolutely confirm would be a tissue biopsy. However, given the difficulty of biopsy or excisional biopsy with this lesion behind the globe, simple observation is reasonable unless the patient starts to lose vision. In the absence of declining vision, this lesion could be observed indefinitely.

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