When the “Eye Falls”

A 56-year-old woman reported a sensation of her left eye "falling out" when bending forward to tie her shoelaces.Orbital and neurologic examinations were unremarkable.Orbital MRI only showed a discrete gadolinium-enhanced focus within the extraconal fat of the left eye (Figure, A, arrow).A repeat MRI in the prone position demonstrated marked expansion of the abnormality, now occupying the lateral rectus muscle and extending into the intraconal and extraconal fat.In this position, the well-delineated lesion displaced the optic nerve medially (Figure, B, star) and caused left-sided exophthalmos.The findings were consistent with an orbital varix, 1 a benign venous malformation that expands with increased venous pressure and is thus revealed on prone acquisition.Orbital varices lack standardized treatment.Surgery/laser ablation may be considered for diplopia or pain.With mild symptoms, our patient was managed with observation only, consistent with reports of stability or spontaneous regression in these cases. 2 Figure Orbital MRI 3DT1 Fat-saturated sequence performed after gadolinium injection in supine (A) and prone (B) positions.