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Photos courtesy of: Carol L. Shields, M.D. Used with permission. Not to be reproduced.

A 4-year-old child was noticed to have ptosis in the left eye since 2 weeks. No other significant history of trauma or familial disease. Visual acuity and ocular movements were normal. Lid crease was good with levator action of 16 mm. The rest of the examination was normal in both eyes. External photograph and MRI of the patient are shown above.

1.	Looking at above pictures, what is the most likely diagnosis?
	c -- rhabdomyosarcoma
2.	Management starts with:
	a -- excision or incision biopsy

Rhabdomyosarcoma is the most common orbital malignancy in children. A short history of ptosis in a child suggests a malignant pathology. Incision biopsy should be done for the confirmation of diagnosis, if the mass is diffusely infiltrated. The above case was proven Rhabdomyosarcoma on excision biopsy of the whole mass in toto. Further, chemotherapy and radiotherapy was given for complete treatment of Rhabdomyosarcoma.

REFERENCES:

1.  Shields JA, Bakewell B, Augsberger Jj, et al. Space occupying orbital masses in
       children: a review of 250 consecutive biopsies. Ophthalmology 1986: 93; 379-384.

2.   Shields JA, Shields CL. Rhabdomyosarcoma: review for the ophthalmologist. The
       2001 Henry Dubins lecture. Surv Ophthalmol 2003:48; 39-57.