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KR is a 28-year-old man who noted some fullness in the outer part of his left upper lid. He thought he could feel some firmness and mild tenderness just below the upper outer rim of the orbital bone. Examination by his ophthalmologist confirmed these findings with inferior displacement of the globe by 2 mm. Echography was performed in the office and showed enlargement of the left lacrimal gland to 18.5 mm and high internal reflectivity, which became lower as the spikes traveled across the gland (Fig. 1). This was suspicious for a benign mixed cell tumor, and he was referred for CT scanning and then to an orbit surgeon for an en bloc excision of the lacrimal gland.

Fig. 1
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A-scan of pleomorphic adenoma of the lacrimal gland (vertical arrows)

Full size image

Anterior orbital lesions can involve the eyelids with resultant swelling. Echography is a very useful office test to quickly screen for such lesions with some posterior extension back into the orbit. A relatively common tumor in children with such presentation is the infantile or capillary hemangioma.

This can grow rapidly with a doubling time of weeks and must be differentiated from more serious tumors such as rhabdomyosarcoma.