Bilateral Orbital Cavernous Hemangiomas

A 42-year-old woman presented with loss of vision and progressive proptosis in her right eye from one year before. Best-corrected visual acuity was 20/30 and 20/20 in her right and left eyes, respectively. A mild relative afferent pupillary defect existed on the right side. Exophthalmometric readings were 27 and 20 mm in the right and left eyes, respectively with no ocular deviation or restriction in motility. Both eyes had unremarkable anterior segments and normal intraocular pressure. Funduscopy revealed right optic disc swelling. Automated per imetry (centra l 24-2 threshold tes t ) demonstrated an enlarged blind spot together with generalized depression in the right eye (Fig. 1) but was normal on the left side. General physical examination, laboratory tests and chest radiography were within normal limits. Orbital computed tomography (CT) scanning showed a round and well-defined homogenous intraconal soft tissue mass, 22 mm in diameter causing severe proptosis in the right orbit and a similar lesion 11 mm in diameter in the superomedial extraconal space in the left orbit (Fig. 2). Orbital magnetic resonance imaging (MRI) revealed the lesions to be hypointense relative to fat on T1-weighted and isointense relative to muscle on T2-weighted images with marked uniform enhancement after gadolinium injection (Fig. 3). Imaging findings were compatible with bilateral orbital