Extraconal Orbital Cavernous Venous Malformations: An Incidental Finding

Cavernous hemangioma, currently classified as a cavernous venous malformation (CVM) according to the International Society for the Study of Vascular Anomalies classification, is the most common benign vascular malformation of the adult orbit. It typically arises within the intraconal compartment. Extraconal orbital CVMs are uncommon and are usually reported as isolated case reports or small case series. A 48-year-old female presented with a gradual diminution of near vision without pain, diplopia, or proptosis. Ocular examination was notable for presbyopia; however, an incidental, painless swelling of the right lower eyelid was also observed. Contrast-enhanced orbital computed tomography demonstrated a well-circumscribed extraconal lesion in the inferolateral orbit with homogeneous enhancement. Complete surgical excision was performed via anterior orbitotomy. Histopathological examination confirmed CVM. This case highlights an uncommon extraconal location with incidental clinical detection, emphasizing the importance of careful periocular examination even in patients presenting with unrelated visual complaints, and thus adds to the small pool of such case presentations.