Orbital Masses in Children

Orbital masses in children have different etiologies than in adults. In newborns and infants, when the eye is abnormal, one must consider a colobomatous cyst of the optic nerve or a teratoma, and if the eye is normal, cysts arising from adjacent structures, such as dacryo(cysto)celes and meningocencephaloceles, or vascular lesions, such as infantile hemangioma (benign hemangioendothelioma/capillary angioma) and lymphangioma, or venous-lymphatic malformations. In older children, malignant tumors are more common, for which ultrasound is less relevant: rhabdomyosarcoma, lymphoproliferative lesions (various forms of histiocytosis, orbital involvement of leukemias, lymphomas), and neuroblastoma metastases. However, one should not forget the possibility of dermoid and epidermoid cysts, nerve tumors (gliomas of the optic nerve, neurofibromas and schwannomas) and vascular lesions (lymphangiomas or venous-lymphatic malformations, vascular malformations). Finally, inflammatory exophthalmos requires first ruling out rhabdomyosarcoma. In case of acute ethmoiditis, ultrasound when performed first, may detect a retroseptal extension.