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A three-month-old baby had been noted to have a ‘film’ over his eye since birth. Examination revealed a conjunctival mass, also involving the superotemporal limbus. Corneal vascularization was also noted; however, there were no other signs of anterior segment inflammation. Fixation and following were present, the eyes were aligned, and no relative afferent pupillary defect (RAPD) was elicited.

* In this exercise, more than one answer can be correct for each question.

1.	Which of the following would you do in managing this child?
	a -- examination under anesthesia; c --conjunctival biopsy; and e -- perform refraction The infant should undergo examination under anethesia and conjuntival biopsy. Deep exploration may lead to complications such as strabismus, restricted ocular mobility, and ptosis. It is also important to perform a refraction – in this case there was 4D with-the-rule astigmatism - and examine the fundi and retina (for any associated ocular findings).
2.	What is/are the likely diagnosis(es)?
	a -- dermoid; b -- lipoma; and d -- choristoma Histology revealed this to be a case of epibulbar choristoma with lacrimal gland elements (the adjacent corneal vascularisation remains unexplained in the absence of inflammation).  Choristomas represent a congenital overgrowth of normal tissues in an abnormal location. The predominant locations are the epibulbar region, adnexae and choroid There are four main sub-types: Dermoids/lipodermoids Single tissue choristoma, complex choristoma Low and high power H&E stains of the conjunctival biopsy illustrating the abnormal glandular architecture within the tissue are shown below:
3.	Associated ocular and systemic associations of this condition include:
	e -- all of the above All of these conditions can be associated with choristomas, and therefore a complete ocular and systemic examination is warranted.