A 5½-YEAR-OLD boy was referred for evaluation of right orbital swelling. His symptoms started 2 months before his referral, with right orbital swelling and difficulty in using his right eye. He was previously treated by his pediatrician with an oral antibiotic and with antimicrobial eyedrops for suspected periorbital cellulitis, but no response was noted.
He had swelling and tenderness of the right supraorbital rim without erythema and a 5-mm right upper eyelid ptosis due to edema. The right globe was depressed (globe ptosis) by 3 mm but was not tender and had full range of movement without pain. The right conjunctiva, fundus, and pupillary reflexes were normal, as were the results of the remainder of his physical examination.
The roentgenogram (Figure 1, left) and computed tomogram (Figure 1, right) of the orbits is shown.
The patient had a normal roentgenographic skeletal survey and normal serum electrolyte levels. Percutaneous biopsy