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Orbital mass in a child

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This 8-year-old girl presented with slow progressive ptosis of the left upper lid and fullness to the left periorbital tissues. There was a dense, nonmobile palpable mass over the lacrimal gland area. By imaging, the mass was separate from the lacrimal gland. The dense presumed fibrosis of the orbit had severely limited the movement of the levator palpebrae superioris without affecting the superior or lateral rectus. The patient underwent an orbital biopsy through a lid crease incision. (Contributed by Dr. Mark Duffy.)