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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 above. Prior to this she was perfectly normal. Early on it took a “considerable period” of time in the 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. At the examination the bulging was noted after bending over for 30 seconds along with fullness of the upper lid. This bulging 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.

1.	This condition is likely to have the following origin:
	a. infection b. solid tumor c. pedunculated mass d. vascular e. none of the above
2.	The diagnostic possibilities include:
	a. varix b. lymphangioma c. hemangioma d. (a), (b), or (c) e. none of the above
3.	A reasonable plan for management would be:
	a. immediate surgery b. chemo-reduction c. irradiation d. observation and clinical follow-up e. none of the above

For answers to the above, click here on or after September 8, 2009.