Some Orbital Confusion

A 64 year old gentleman was referred for progressive horizontal diplopia.In September 2006 he had been referred for a second opinion regarding a 5 year history of intermittent swelling around the right orbit, worsening over 7 months associated with double vision, and proptosis (C,D).Acuity was 20/25. 24-2 demonstrated moderate diffuse depression OD > OS, and some arcuate VF changes OS. Palpebral fissures were 13 and 10 with an upper lid range of 15 and 12. Hertels 28/19 with some resistance to retropulsion. There was no APD, but definite limitation in elevation > abduction, adduction, and depression OD with 100 seconds stereopsis. Applanation tensions were 16 and 12. OCT demonstrated minimal thinning of NFL superiorly and nasally, but symmetric OU. CT scan (A,B) demonstrated R orbital pathology.Flow CytometryReview of the original orbital pathology failed to confirm malignancy and a repeat orbital biopsy was planned.ChlorambucilAttache