Pulsating exophthalmos: orbital tumors in siblings

The extremely rare occurrence of sibling brothers with left pulsating exophthalmos has been presented with very similar plain film and CT scan findings. Other patients presented demonstrate the strong familial trend of neurofibromatosis, the multiplicity of lesions, the progression of lesions. Genetic counseling is indicated, together with educating the patient and family as to further neurologic deficits which may develop. On-going evaluation at intervals is indicated. Significant cases should only be approached surgically with the realization of the seriousness of what both the patient and doctor may encounter. Surgery, unfortunately, usually cannot offer much help. An interdisciplinary approach with the surgeon, plastic surgeon, neurosurgeon, and ophthalmologist offers a safer approach.