ORBITAL VENOUS ANOMALIES

Purpose: The purpose of the study is to establish the natural history, probable nature, and optimal treatment of lesions within the orbit de scribed previously as lymphangiomas or orbital varices. Methods: The c linical and radiologic records of 158 patients with these lesions were reviewed, Of these, 91 had surgery, and histologic specimens from 57 were re-examined. Results: Most patients were infants or children with a dark blue swelling in the superomedial part of the orbit, orbital h emorrhage, or proptosis, Computed tomography showed smooth, contoured lesions denser than brain extending posteriorly. Half enlarged with th e Valsalva maneuver, 31% contained phleboliths. Surgery was performed in 91 patients, mainly for cosmesis. Excised tissue included endotheli um-lined channels containing blood in the orbit and clear fluid in man y superficial specimens, Conclusions: The behavior of these lesions an d their prevalence in infancy and childhood favor a hamartoma. The aut hors observed a seamless range of clinical features that they could no t subdivide, particularly in relation to any connection with the orbit al veins. Many bleed and enlarge permanently and need excision, but su rgery is difficult and management should be as conservative as possibl e. The origin of these lesions cannot be determined by histopathologic analysis, although the authors have evidence of venous features in th e orbit and lymphatic features more superficially. The authors' clinic al findings support a venous origin, Two-thirds have either a free ven ous connection or phleboliths. Their distribution corresponds with tha t of the normal orbital veins, and at surgery they derive from or repl ace those veins. ''Orbital venous anomaly'' is the most accurate term for their description.