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General

• most common benign solitary lesion in adults
• 30-60 year old female is typical
• slow axial proptosis over 3-5 yrs, averaging 5mm

• retinal striae
• hyperopia
• strabismus
• Optic nerve compression
• rapid growth in pregnancy
• increased intraocular pressure

 

Imaging

• CT: smooth discrete lesion, fills with dye after 20 min; coronal cuts important to know tumor position relative to optic nerve. for sugical plan
• MRI: hypointense to fat on T1, hyperintense to fat on T2
• U/S: high reflectivity (A-scan high amplitude internal echoes)

Pathology

• well encapsulated and tolerated
• shows large cavernous spaces with red blood cells

Surgery

• surgery for symptoms especially optic nerve compression
• usually lateral orbitotomy with complete resection from intraconal position generally feasible