Author(s): Sagarika Laad, Harpal Singh, Rajesh Shapat Pattebahadur, Pranav Saluja, Parag Ramnani

A 23-year-old male presented to eye OPD with complain of mass in left eye since the last 3 years. He developed mild pain and redness in the same eye since the last 10 days. There was no history of trauma, foreign body or any other relevant history. No history of any systemic illness. Vision was 6/6 in right eye and 6/36 in left eye recorded on Snellen’s chart. Ocular movements were normal. On slit lamp examination of left eye, irregular growth on nasal side extending from upper fornix to lower fornix upto medial one third under the conjunctiva with overlying dilated vessels and subconjunctival haemorrhage was seen. Other anterior segment examination was normal. Right eye was normal. Fundus examination showed normal disc with dilated and torturous blood vessels in left eye more than right eye. On Valsalva manoeuvre, eye proptosed 2-3 mm. We then went for MRI orbit with contrast which revealed multiple abnormal segmentally dilated club like vascular channels at the orbital apex at both intra and extra conal retrobulbar space and median canthus of the left orbit. These vascular channels appeared hypointense on T1-weighted and hyperintense on T2-weighted sequence. The retrobulbar lesion showed post contrast enhancement however medial canthal lesions showed minimal post contrast enhancement suggesting thrombosis. This left intra orbital vascular malformation was suggestive of orbital venous varix.