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JJ is a 26-year-old man who complained of reduced vision in his left eye over several weeks. Examination by his ophthalmologist found uncorrected vision OD of 20/20 and OS of 20/60, but this eye could be refracted to 20/20 with a +2.50 lens. Hertel exophthalmometry showed 2 mm of proptosis OS. Fundus examination found choroidal folds in this eye.

Echography was performed at this time and showed a low-reflective well-outlined lesion in the retrobulbar space (Fig. 1). The differential diagnosis included cystic lesions, such as a hematic cyst, dermoid, or lymphangioma. The patient gave no history of trauma. He opted for surgical removal of the lesion, and a cystic structure was found with blood breakdown products consistent with a hematic cyst. The patient experienced a complete resolution of his symptoms after surgery.

Fig. 1
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Left: B-scan of hematic cyst (arrow). Right: A-scan of lesion (first two arrows). Multiple signal (third arrow)

Full size image

Hematic cysts are rare orbital lesions that are most often subperiosteal and may or may not be related to trauma [47]. A fibrous capsule surrounds an area of inflammatory reaction to blood or blood breakdown products, such as hemosiderin.

Mass lesions in the orbit that are separate from the optic nerve can cause reduced vision by direct compression of the optic nerve. This is more common with slowly growing tumors that enlarge over time to the degree that they can press on the nerve with varying degrees of proptosis.