How do you approach the management of indeterminate orbital lesions in asymptomatic patients with inconclusive imaging findings?

I feel like there is a specific case here. If so, I’d love to hear the details.

That said, I’d return to the differential diagnosis of orbital masses/issues with the popular VEIN mnemonic - vascular, endocrine (thyroid), inflammatory, and neoplastic. While inflammatory lesions are commonly painful, they may not necessarily be so.

Laboratory studies can sometimes help direct the differential towards or away from inflammatory etiologies, as can patient demographics and a thorough history. Examining for proptosis induced by the Valsalva maneuver could direct you towards a vascular malformation, whereas proptosis worsened with a minor illness may direct you towards lymphangioma.

Imaging is helpful both for surgical planning and diagnosis. Of co...