Lesions causing a mass in the medial canthus of the orbit: CT and MR features

Few detailed radiologic articles treat the medial canthus as a "compartment" of the orbit. Nasal stuffiness and epiphora (excessive tearing) are frequent clinical manifestations of diseases involving the medial canthus of the orbit. Although some lesions can be adequately evaluated by clinical examination, imaging may show unsuspected deep extensions of the abnormality. CT has traditionally been the imaging method of choice because of the inherent contrast between structures in this region and its superb depiction of bone detail (Fig. 1). MR imaging can be useful in detecting subtle marrow invasion caused by lesions extending beyond the confines of the medial canthus (e.g., frontal bone, maxilla). In this pictorial essay, we illustrate the CT and MR appearances of diseases that can manifest as a medial canthal mass and provide practical differential diagnoses. Lesions can be inflammatory, neoplastic, or developmental in origin. Moreover, these lesions can result from abnormalities in the adjacent nasolacrimal apparatus, orbit, paranasal sinuses, and nasal cavity, or they can reflect an underlying systemic illness.