# Case Report: an unusual orbital tumor

## TL;DR

A rare case of orbital lipoma in a 63-year-old patient is reported, highlighting its clinical presentation, diagnostic challenges, and successful treatment.

## Contribution

This case report adds to the limited literature on orbital lipomas and emphasizes the importance of histology for accurate diagnosis.

## Key findings

- The patient presented with diplopia and limited elevation of the right eye due to a fusiform fatty lesion in the inferior rectus muscle.
- Complete tumor excision via a transconjunctival approach led to full recovery with no recurrence after 3 years of follow-up.
- Histopathological confirmation was essential for diagnosis, as clinical evaluation alone was insufficient.

## Abstract

Introduction

Orbital lipoma is an extremely rare tumor, representing less than 1% of all orbital tumors. We review the literature and describe the presentation, the differential diagnosis and the management of this tumor.

Case report

We report the case of a 63-year-old patient who was referred for a diplopia with recent hemi-cranial headache. Physical examination showed no exophthalmos nor decrease in visual acuity. The patient complained of diplopia on elevation and oculomotricity examination showed limited elevation of the right eye. The Hess Lancaster test was in favor of a limited course of the right inferior rectus muscle. Magnetic resonance imaging revealed a fusiform tissue process in the right inferior rectus muscle with a fatty signal. A complete excision of the tumor was performed by a trasncunjonctival approach. Cytopathological examination was consistent with a pleomorphic lipoma. The postoperative period was uneventful. The definitive histopathologic diagnosis was a lipoma. The postoperative Magnetic resonance imaging showed the complete disappearance of the lesion. With 3 years of follow up, there is no sign of recurrence or ocular motility trouble.

Conclusion: Lipomas are rare tumors in the orbit. The clinic is variable depending on the size and the site. The clinical diagnosis is difficult to make. Only histology allows the final diagnosis.