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ORBITAL MASS
Because most orbital masses cause exophthalmos, the differential diagnosis of the two is very similar (for illustration see section on exophthalmos, page 193). The best method to use to arrive at the causes is to visualize the anatomy of the orbit and then to think of the mnemonic MINT.
- Subcutaneous tissue. Subcutaneous tissue proliferation in the orbit occurs in hyperthyroidism. There may be an orbital cellulitis or orbital hemorrhage into the subcutaneous tissue. Wegener granulomatosis, orbital cysts, sarcomas, and metastatic carcinomas may occur here.
- Eyeballs. An orbital echinococcal cyst may occur. Tumors, infections, and trauma to the eyeball may occasionally spread to the orbit.
- Veins. These are distended in cavernous sinus thrombosis, carotid–cavernous fistulas, and hemangiomas.
- Arteries. Aneurysms of the ophthalmic artery are rare but they may cause an orbital mass.
- Lacrimal gland. Tumors and inflammation of this gland (e.g., in Boeck sarcoid) should be remembered.
- Sinuses. Inflammatory lesions and tumors of the sinuses may spread to the orbit.
- Bone. Sphenoid ridge meningiomas, metastatic carcinomas, tuberculous or syphilitic orbital periosteitis, and Hodgkin disease may involve the bones of the orbit. Orbital fractures and hematomas may result from trauma.
The workup of these lesions is similar to the workup for exophthalmos (see page 193).
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8 
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