Cornea & external disease · practice question
Management: [READINESS SEED] An infant has a soft swelling at the superomedial orbit…
[READINESS SEED] An infant has a soft swelling at the superomedial orbit that enlarges when the baby cries and transmits a pulsation, without an overlying bruit. What is the most appropriate next step?
Show the answer and explanationAnswer and explanation
Answer: A. Imaging for an intracranial connection
A soft superomedial mass that pulsates and enlarges with crying or Valsalva suggests an orbital meningo- or encephalocele: herniation of meninges, with or without brain, through a congenital bony-wall defect that transmits cerebrospinal-fluid pulsation. Because it communicates with the cranial cavity, computed tomography (bony defect) and magnetic resonance imaging (intracranial connection) precede any intervention — blind biopsy or aspiration risks a fluid leak, meningitis, and injury to herniated neural tissue. Repair is neurosurgical. It is distinguished from a congenital dacryocele, which lies below the medial canthal tendon.
Clinical pearl: Definitions: meningocele = meninges only; meningoencephalocele = brain plus meninges; encephalocele = brain tissue. Orbital ones are often heterotopic, superomedial, and frontoethmoidal. Pulsatile proptosis *without* a bruit signals a bony-defect herniation, separating it from a bruit-positive carotid–cavernous fistula.