To see views enlarged, click on the individual pictures...

This 51-year-old woman complains that her right eye is becoming more prominent.  This began about two years ago.  She does not complain of any pain, she has no other physical complaints and appears to be in good general health.  She has had no recent weight loss, her appetite is normal, and her pulse rate is normal. Vision is OD 6/60 and OS 6/6.  Refraction is OD plano, OS +1.50.  The IOP is 16 mm Hg in both eyes, the media are clear and there is no obvious fundus abnormality.

1.	This proptosis could be caused by?
	a -- cavernous hemangioma
2.	How would you manage this case?
	c -- orbitotomy with biopsy This woman would benefit from an orbitotomy with biopsy.  Probably the best diagnosis would be cavernous hemangioma.  Lymnphoma would be difficult to debulk.  An optic nerve glioma would require resection that would sacrifice vision.
3.	When this lady asks about what her vision is likely to be a year from now, what would your answer would be?
	a -- it depends on the diagnosis The vision postoperatively would depend on the diagnosis.  For that reason it is not a good idea to give too firm a prediction.  A cavernous hemangioma would probably be the best diagnosis for better postoperative vision.